The lipids of aging brain were studied using a comparative-evolutionary model involving two species of mice, Mus Musculus (Mus) and Peromyscus leucopus (Peromyscus). Mus ages 2.5 times faster than does Peromyscus. Brain weight, water content, cholesterol, and ethanolamine plasmalogen decreased and phosphatidyl ethanolamine increased in both species with age. Differences between species included 12% more cholesterol/g total lipid extract in Peromyscus than in Mus throughout life, a linear increase with age in lipid phosphorus/g fresh weight at a faster rate in Peromyscus over Mus, and a linear increase in the total lipid extract weight throughout life in Mus but a decrease in Peromyscus. Cerebroside, sulfatide and GM1 ganglioside all increased during maturation and then decreased in old age in both mice. Lipid-bound sialic acid (ganglioside) increased linearly throughout life in Peromyscus but decreased slightly in Mus. These changes are interpreted to mean that the cellular membranes of Peromyscus may be inherently more stable than those of Mus, Peromyscus is better able to preserve its neuronal cell population with age than is Mus, proliferation of non-myelin membranes may occur in both species in advanced age, and both species of mice may experience some loss of myelin with age.

Aging↗

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Dietary alteration in the rates of cancer and aging.

Both variation of diet and comparative analysis are used to evaluate the effects of nutrition on mortality and cancer. The effects of caloric restriction (CR) are compared in multiple strains raised under similar conditions for a diet developed to assist breeding, and for a standard diet. A standard analysis, using "aging rates," is of limited use for understanding the effects of CR in delaying mortality in certain strains. However, when the effect of the diets on body weight and the known effects on sex-specific P-450 isoenzyme expression are compared, these effects suggest a mechanism for the action of CR. By comparative analysis, the effect of CR on tumor pathology suggests that the same mechanisms responsible for inhibiting reproduction may be responsible for delaying the aging-related increase in incidence of diseases. Based on these data, the adaptive/longevity-related process theory of CR is modified to incorporate aspects of the disposable soma theory of aging, as well as pleiotropism.

Aging↗

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Effects of aging and dietary restriction on DNA polymerases: gene expression, enzyme fidelity, and DNA excision repair.

Hepatic DNA polymerases isolated from young and old C57BL/6N mice fed ad libitum or calorically restricted differed in chromatographic characteristics, binding affinity for DNA template-primer, specific activity, and fidelity of synthesis. DNA polymerase alpha total and specific activity declined slightly, while the nucleotide misincorporation frequency increased dramatically, with increased age of the donor animals. A positive correlation was observed between polymerase alpha specific activity and the affinity of enzyme binding to activated DNA template-primer. Both the age-associated decline in enzyme activity and the decrease in fidelity of synthesis were modified by dietary restriction, with higher specific activity levels and lower misincorporation frequencies for DNA polymerases from dietarily restricted animals compared with ad libitum animals of all ages. Fidelity of both DNA polymerase alpha and beta increased following treatment with the phosphoinositide hydrolysis product inositol-1,4-bisphosphate. The data suggest that dietary restriction could play an important role in decreasing the age-associated decline in function of physiological systems sensitive to decreased or defective DNA synthesis.

Aging↗

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Potential utility of rubidium 82 PET quantification in patients with 3-vessel coronary artery disease.

BACKGROUND: Standard perfusion imaging may underestimate the extent of disease in 3-vessel coronary atherosclerosis. This study determined whether positron emission tomography quantification of perfusion reserve by use of rubidium 82 net retention defined a greater extent of disease than the standard approach in patients with 3-vessel disease. METHODS AND RESULTS: Rb-82 net retention was quantified as an estimation of absolute perfusion at rest and with dipyridamole stress by use of dynamic positron emission tomography imaging. The percent of abnormal myocardial sectors, as compared with a normal database, for a standard and quantification approach was determined. Twenty-three patients were evaluated. Defect sizes were larger in patients with 3-vessel disease (n = 13) by use of quantification methods: 44% +/- 18% of the myocardial sectors were abnormal by use of the standard approach versus 69% +/- 24% of sectors when measured by quantification of the stress-rest perfusion difference (P =.008). In patients with single-vessel disease (n = 10), defect sizes were smaller with quantification methods. CONCLUSIONS: Quantification of Rb-82 net retention to measure the stress-rest perfusion difference in the myocardium defined a greater extent of disease than the standard approach in this group of patients with triple-vessel disease. More accurate measurement of the extent of coronary artery disease could facilitate better risk stratification and identify more high-risk patients in whom aggressive intervention is required.

Aged↗

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Pediatric death: managing the aftermath in the emergency department.

Managing the family conference in the emergency department after the sudden death of a child is difficult and, when mishandled, can be deleterious to the patient's family. We surveyed parents of children who died in an emergency department setting in an effort to elicit information that will help emergency physicians tell parents that their child has died. A 24-question survey was distributed to 60 parents identified by the Illinois chapter of the Sudden Infant Death Syndrome Alliance. Results were included if the parents indicated that their child was pronounced dead on arrival or died in an emergency department. If the victim was over 16 years of age, had a terminal illness, or died after hospitalization, results were excluded. Thirty-seven parents completed the survey. Seventy-six percent felt that it was the attending physician's responsibility to inform the family that the child had died. Holding the dead child was helpful for 88%. Seventy-six percent felt that being asked about organ donation would not be offensive. For most parents, having the child's clothes returned was important. Fully 92% of the respondents would have liked a physical memento of the child, such as a print or mold of the child's hand or a lock of hair. Most parents felt that a follow-up telephone call would be helpful, although only a small minority received such a call. Parents whose child died in an emergency department provided some concrete suggestions for emergency physicians regarding informing parents that their child died. Although the majority of children died of sudden infant death syndrome, the results may be applicable to other pediatric deaths.

Attitude to Death↗

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[The Weil osteotomy in metatarsalgia].

AIM: The purpose of the prospective study is to evaluate the results of Weil osteotomy in painful overloaded central forefoot with dislocation of the MTP joint. METHOD: 19 left and 16 right feet underwent the Weil osteotomy. In 10 patients the procedure was performed on both feet. In 15 cases only one metatarsal was corrected (the 2 (nd) in 12 and the 3 (rd) in 3 cases), in 17 cases both the 2 (nd) and the 3 (rd) metatarsals and in 4 cases also with the 4 (th) one together. The simultaneous correction of hallux valgus was performed in 19 forefeet. The mean follow-up was 31 months (range, 19 to 41 months). RESULTS: All patients were satisfied with the result of the operation. The results were excellent in 29 cases (83 %) and good in 6 cases (17 %). The plantar callus disappeared in 27 feet (77 %) and decreased in 8 feet (23 %). In one patient the new callus formed under the head of the neighbouring metatarsal bone. The sufficient MTP joint reduction was found in 31 cases (89 %). CONCLUSION: It is possible with the Weil osteotomy to correct the metatarsal length accurately according to the preoperative planning. This results in the prevention of new callus formation under the neighbouring metatarsal head. Stable internal fixation allows the early mobilisation of the MTP joint.

Adult↗

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Treatment of deep cartilage defects of the knee using autologous chondrograft transplantation and by abrasive techniques--a randomized controlled study.

AIM OF THE STUDY: To compare outcomes of surgical treatment of deep cartilage defects of the knee in a group of patients treated by autologous chondrograft transplantation versus patients treated by abrasive techniques. MATERIALS AND METHODS: An original method of chondrograft preparation based on cultivated autologous chondrocytes in a three-dimensional carrier - fibrin glue (Tissucol, Baxter, Austria) has been described. Preclinical tests in human cadavres and porcine models have established the possibility of chondrograft use in humans. Of the 50 patients included in the study, 25 patients (50%) underwent autologous chondrograft transplantation (group I) and 25 patients (50%) were treated using abrasive techniques according to Johnson (group II). These two groups were similar with respect to age, size of defect, depth and localization, and presence of concomitant knee injuries. The Lysholm knee and IKDC (International Knee Documentation Committee) subjective scores were used to evaluate the results. RESULTS: The preoperative value of the Lysholm knee score for patients in group I was 47.60 points; 5 months after surgery 77.20 points; and 12 months after surgery 86.48 points. The values for the Lysholm knee score for patients in group II preoperatively, 5 months postop, and 12 months postop were 52.60, 69.20, and 74.48 respectively. Results 12 months after surgery were significantly better in group I as compared to group II (p < 0.001). The preoperative value of the IKDC subjective score in group I was 41.28 points; 5 months after surgery 67.00 points; and 12 months after surgery 76.48 points. The values for the IKDC subjective score in group II preoperatively, 5 months postop, and 12 months postop were 45.00, 62.28, and 68.08 respectively. Results 12 months after surgery were significantly better in group I when compared to group II (p < 0.05). CONCLUSIONS: The results obtained in this study have confirmed the better outcome in patients treated with autologous chondrograft transplantation. This original method was found to be just as effective as abrasive techniques. We recommend its use in clinical practice.

Adolescent↗

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Comparison of discomfort associated with surface and percutaneous intramuscular electrical stimulation for persons with chronic hemiplegia.

Neuromuscular stimulation may facilitate motor recovery after stroke or brain injury, reduce shoulder pain associated with hemiplegia, and reduce cerebral spasticity. However, the discomfort of surface neuromuscular stimulation significantly limits the clinical implementation of this modality for persons with hemiplegia. The study contained herein tests the hypothesis that stroke and brain injury survivors with chronic hemiplegia (>6 mo) and intact sensation tolerate percutaneous intramuscular stimulation better than surface stimulation. Four stroke and two traumatic brain injury survivors participated in the study contained within this article. Each subject received three pairs of percutaneous and surface stimulations of the paretic finger extensors. The order of the type of stimulation within each pair was randomly assigned. The stimulation parameters for each type of stimulation were normalized to produce the same torque at the metacarpophalangeal joint. Subjects rated their perceived level of discomfort using a 10-cm visual analog scale and the McGill Pain Questionnaire. A blinded evaluator administered the pain measures. Percutaneous stimulation was associated with significantly lower discomfort as reflected by the visual analog scale (0.74 v 3.3; 95% confidence interval of difference, -3.84, -1.28). The McGill Pain Questionnaire produced similar results with percutaneous stimulation associated with a significantly fewer number of words chosen to describe the discomfort (0.87 v 3.30; 95% confidence interval of difference, -3.50, -1.30) and significantly lower Pain Rating Index (1.47 v 6.27; 95% confidence interval of difference, -7.77, -1.83). Data suggest that percutaneous intramuscular stimulation is significantly better tolerated than surface stimulation and that percutaneous stimulation may enhance patient compliance with neuromuscular stimulation treatments.

Adolescent↗

PubMedDate not supplied

Mechanisms of perioperative cerebral infarction.

Perioperative cerebral infarction occurs in less than 1% of general surgical procedures; the mechanism is usually unknown. The clinical features of 12 consecutive perioperative strokes were retrospectively reviewed. Although intraoperative hypotension was frequent, onset of deficit occurred postoperatively in 83% and intraoperatively in 17%. Cardiogenic embolism was a common cause of stroke (42%), with atrial fibrillation present in 4 patients (33%) at the time of stroke. The potential roles of hypercoagulability, hypotension and carotid occlusive disease are discussed. Future reports concerning perioperative stroke should consider the multiple mechanisms and temporal relationship of stroke to the operative procedure.

Aged↗

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Atrial fibrillation and the diagnosis of cardioembolic stroke.

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Aged↗

PubMedDate not supplied

Calcific cerebral emboli and aortic stenosis: detection of computed tomography.

Embolism with brain infarction rarely complicates calcific aortic stenosis (CAS). We report a case with severe CAS where the patient experienced multiple embolic strokes immediately following retrograde heart catheterization. Calcific emboli in the cerebral arteries were demonstrated by computed tomography (CT).

Aged↗