Clinical Interventions in Aging

Published by Dove Medical Press
Online ISSN: 1178-1998
Publications
Incidence of dry skin among patients in the TDiclo, placebo, and control groups. Note: Significant differences between groups are indicated. Abbreviation: TDiclo, diclofenac sodium topical solution. 
Baseline demographics of patients 
Clinical characteristics of patients 
Incidence of application site-related adverse events among patients in the TDiclo, placebo, and control groups. Abbreviation: TDiclo, diclofenac sodium topical solution. 
Incidence of treatment-emergent skin or subcutaneous tissue and gastrointestinal adverse events affecting $1% of patients 
Article
This study aimed to determine the safety of diclofenac sodium topical solution 1.5% (w/w) in 45.5% dimethyl sulfoxide (TDiclo) for the treatment of knee or hand osteoarthritis in persons aged 75 years or older. A pooled analysis of safety data from seven multicenter, randomized, blinded, Phase III clinical trials (4-12 weeks' duration) of TDiclo was conducted. The analysis focused on a subset of patients (n = 280) aged 75 years or older with a primary diagnosis of osteoarthritis of the knee (six trials) or hand (one trial). Patients received one of three topical treatments: TDiclo (n = 138); placebo (2.33% or 4.55% dimethyl sulfoxide, n = 39); or control (45.5% dimethyl sulfoxide, n = 103). Treatment groups were compared using Chi-square analysis, Fisher's Exact test, or analysis of variance. The most common adverse events involved the skin or subcutaneous tissue, primarily at the application site. The incidence of dry skin was higher in the TDiclo (36.2%; P < 0.0001) and dimethyl sulfoxide control (18.4%; P = 0.0142) groups than in the placebo group (2.6%); the incidence of other skin or subcutaneous tissue adverse events was similar between the groups. Relatively few patients (<18%) experienced gastrointestinal adverse events, and group differences were not detected. In the TDiclo group, constipation (3.6%), diarrhea (3.6%), and nausea (3.6%) were the most common gastrointestinal adverse events. Cardiovascular and renal/ urinary adverse events were rare, and group differences were not detected. There was one case (0.7%) each of hypertension, spider veins, and vasodilation in the TDiclo group. Changes from baseline to the final visit in blood pressure and hepatic/renal enzyme levels were also similar between the groups. TDiclo appears to be well tolerated for the treatment of osteoarthritis in persons aged 75 years or older.
 
Article
Depression is common in elderly stroke survivors and has been associated with systemic inflammation. We aimed to investigate an elderly population of Swedish stroke patients for evidence of sustained peripheral inflammation 18 months post-stroke and to identify if inflammation is associated with post-stroke depression at 18 months post-stroke. The Barthel Index was used to measure the level of impairment in activities of daily living at 3 days post-stroke. Serum concentrations of inflammation markers, ie, C-reactive protein and white cell count, were measured in 149 stroke patients (mean age 81 ± 5.33 years, 35% male) at 18 months post-stroke, and a comparison was made with an age-matched sample of elderly Swedish individuals who had not suffered a stroke. At the same visit, clinical depression was diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders, Third Edition-Revised criteria. Severity of depression was assessed using the Montgomery-Asberg Depression Rating Scale (MADRS). Mean C-reactive protein and white cell count levels in stroke patients were significantly elevated at 18 months post-stroke compared with population probands. Disability scores were associated with MADRS depression scores, but C-reactive protein and white cell count were not. We found evidence for a sustained peripheral inflammatory response at 18 months post-stroke. C-reactive protein and white cell count were not associated with depression in this study.
 
Article
Critical to survival is the geriatric concept, allostasis, defined as the ability to achieve stability through change. It is appropriate that allostasis is an introduction to this commentary, which may partially apply to the medical and pharmacy profession as currently constituted.
 
number of deaths and mortality rates over 11 years, by tertiles of energy expenditure at baseline 
Article
To investigate the association between physical activity (eg, energy expenditure) and survival over 11 years of follow-up in a large representative community sample of older Brazilian adults with a low level of education. Furthermore, we assessed sex as a potential effect modifier of this association. A population-based prospective cohort study was conducted on all the ≥60-year-old residents in Bambuí city (Brazil). A total of 1,606 subjects (92.2% of the population) enrolled, and 1,378 (85.8%) were included in this study. Type, frequency, and duration of physical activity were assessed in the baseline survey questionnaire, and the metabolic equivalent task tertiles were estimated. The follow-up time was 11 years (1997-2007), and the end point was mortality. Deaths were reported by next of kin during the annual follow-up interview and ascertained through the Brazilian System of Information on Mortality, Brazilian Ministry of Health. Hazard ratios (95% confidence intervals [CIs]) were estimated by Cox proportional-hazard models, and potential confounders were considered. A statistically significant interaction (P<0.03) was found between sex and energy expenditure. Among older men, increases in levels of physical activity were associated with reduced mortality risk. The hazard ratios were 0.59 (95% CI 0.43-0.81) and 0.47 (95% CI 0.34-0.66) for the second and third tertiles, respectively. Among older women, there was no significant association between physical activity and mortality. It was possible to observe the effect of physical activity in reducing mortality risk, and there was a significant interaction between sex and energy expenditure, which should be considered in the analysis of this association in different populations.
 
Summary of fracture data among bisphosphonates
Article
Fragility fractures that occur as a result of osteoporosis are frequently associated with chronic pain and decreased quality of life as well as significant morbidity and mortality. Fracture reduction, however, is often less than optimal due to poor compliance with medications. Studies have demonstrated that risedronate, a heterocyclic nitrogen containing bisphosphonate can reduce vertebral, nonvertebral, and hip fracture incidence in postmenopausal women, in men, and in subsets of older patients at great risk of falls and fragility. The mechanism, efficacy, dosing options, and tolerability of risedronate are reviewed.
 
Mean differences of the ratings in the GBS-I, GBS-E, and GBS-ADL subscales by the family caregivers in the intervention group and control group, between baseline and 6, 12 and 18 months respectively for the survivors.
Abbreviations: GBS-I, Gottfries-Bråne-Steen scale-intellectual; GBS-E, Gottfries-Bråne-Steen scale-emotional; GBS-ADL, Gottfries-Bråne-Steen scale-activity of daily living; mths, months.
Article
The purpose of this study was to examine if psychosocial intervention for family caregivers made any differences in describing symptoms of dementia in the persons they cared for. The study population comprised family caregivers of persons aged 70 years and older receiving social services and diagnosed with dementia disorders. A group of 129 family caregivers underwent psychosocial intervention including education, information, and provision of a support group, while 133 family caregivers did not and these formed the control group. Family caregivers were followed-up every 6 months for a total of 18 months. They rated intellectual, emotional, and activity of daily living (ADL) functions in persons with dementia using the Gottfries-Bråne-Steen scale (GBS-scale). Family caregivers who underwent psychosocial intervention rated the intellectual and emotional symptoms of dementia significantly higher 6 months later compared to controls and the effect was sustained during the 18-month follow-up irrespective of relationship and education. Most notably, decrease in function of recent memory, ability to increase tempo, long-windedness, distractibility, and blunting were better identified. Our findings suggest that the family caregivers who underwent psychosocial intervention achieved better understanding of different symptoms and the behaviors of dementia. These findings may explain earlier findings of positive effects after psychosocial intervention on family caregivers' sense of burden, satisfaction, and ability to delay nursing home placement.
 
Effects of incubation of human normal and OA chondrocytes, at basal conditions; with REAC TO-RGN treatment alone; with IL-1β (5 ng/mL) alone; or coincubation with IL-1β and REAC TO-RGN treatment for 48 h in the culture medium. (A) The quantity of PG (ng/10 6 ); (B) the MMP-3 level (ng/10 6 cells); and (C) the NO production (ng/10 6 cells). Note: Data are expressed as mean values ± SD. Abbreviations: OA, osteoarthritis; REAC, radioelectric asymmetric conveyer technology; TO-RGN, Regenerative Tissue Optimization; IL, interleukin; PG, proteoglycan; MMP, metalloproteinase; NO, nitric oxide.
Number (n) of mitochondria, Golgi bodies and presence of vacuolization (percentage, %) in normal and OA chondrocytes, under basal conditions and after treatment with the REAC TO-RGN, in absence or presence of IL-1β (5 ng/mL)
TEM micrographs of human OA chondrocytes. ( A ) Basal conditions: The cell shows an euchromatic nucleus (N), a reduction in cytoplasmic components, such as rough endoplasmic reticulum (RER) and mitochondria (M). The plasma membrane presents cytoplasmic processes. ( B ) Incubation with REAC TO-RNG: The nucleus (N) is euchromatic; the cytoplasm shows a significant increase of the presence of rough endoplasmic reticulum and mitochondria (M). ( C ) Incubation with IL-1 b : The cytoplasm shows a diffuse vacuolization (V) and it contains a reduced quantity of typical organelles, such as Golgi bodies, rough endoplasmic reticulum and mitochondria (M). ( D ) Incubation with REAC TO-RNG + IL-1 β : The cell partially restores its morphology. The nucleus (N) is euchromatic, the cytoplasm shows a restored organization: a much reduced number of vacuoles (V) is present, rough endoplasmic reticulum is abundant and mitochondria (M) are well shaped. The plasma membrane presents many cytoplasmic processes. Bar = 1 μ m. Abbreviations: TEM, transmission electron microscopy; OA, osteoarthritis; REAC, radioelectric asymmetric conveyer technology; TO-RGN, Regenerative Tissue Optimization; IL, interleukin; RER, rough endoplasmic reticulum; M, mitochondria; N, nucleus; V, vacuoles. 
Article
Osteoarthritis (OA) is a degenerative disease characterized by a progressive loss of articular cartilage extracellular matrix and is due to functional impairments occurring in chondrocytes. In previous works, we highlighted that Regenerative Tissue Optimization (TO-RGN) treatment with radioelectric asymmetric conveyer (REAC) technology influenced the gene expression profiles controlling stem cell differentiation and the pluripotency of human skin-derived fibroblasts in vitro. Since interleukin-1 beta signaling has been implicated in the induction and progression of this disease (through metalloproteinase-3 synthesis and nitric oxide production), we investigated whether REAC TO-RGN might influence the biochemical and morphological changes induced by interleukin-1 beta in normal and OA chondrocytes. The induction of metalloproteinase-3 and proteoglycan synthesis was evaluated by a solid-phase enzyme-amplified sensitivity immunoassay, and nitric oxide production was evaluated with the Griess method. Ultrastructural features were observed by transmission electron microscopy. REAC TO-RGN treatment decreased nitric oxide and metalloproteinase-3 production in normal and OA chondrocytes, while inducing an increase in proteoglycan synthesis. OA chondrocytes were more affected by REAC TO-RGN treatment than were normal chondrocytes. Ultrastructural changes confirmed that REAC TO-RGN may counteract the negative effects of interleukin-1 beta incubation. The results of this in vitro study suggest that REAC TO-RGN treatment may represent a new, promising approach for the management of OA.
 
Atorvastatin improved the spatial learning and memory of rats impaired by Aβ1-42, using the Morris water maze test. (A) Escape latency onto a hidden platform; (B) probe test; and (C) working memory.
Abbreviations: Aβ, amyloid-beta (peptide); AD, Alzheimer’s disease; S, second.
Pathological changes in the hippocampus of rats in each group on day 7 after Aβ injection (original magnification × 400). (A) Control group; (B) atorvastatin control group; (C) AD group; and (D) atorvastatin-treated AD group.
Abbreviations: Aβ, amyloid-beta (peptide); AD, Alzheimer’s disease.
Atorvastatin attenuated IL-1β expression in the hippocampus of Aβ1-42-treatedrats. The upper panel shows IL-1 β-positive cells in the rat hippocampus, detected by immunohistochemistry on day 7 after Aβ injection (original magnification x 400). (A) Control group (Group 1); (B) atorvastatin control group (Group 2); (C) AD group (Group 3); and (D) atorvastatin-treated AD group (Group 4). (E) The lower panel shows the counted number of IL-1 β-positive cells in rat hippocampus.
Notes: Data are the mean ± SD of each individuals. *P < 0.01.
Abbreviations: Aβ, amyloid-beta (peptide); IL, interleukin; AD, Alzheimer’s disease.
Atorvastatin attenuated IL-6 expression in the hippocampus of Aβ1-42-treated rats. The upper panel shows IL-6-positive cells in the rat hippocampus, detected by immunohistochemistry on day 7 after Aβ injection (original magnification x 400). (A) Control group (Group 1); (B) atorvastatin control group (Group 2); (C) AD group (Group 3); and (D) atorvastatin-treated AD group (Group 4). (E) The lower panel shows the counted number of IL-6-positive cells in rat hippocampus.
Notes: Data are the mean ± SD of each individuals. *P < 0.01.
Abbreviations: IL, interleukin; Aβ, amyloid-beta (peptide); AD, Alzheimer’s disease.
Atorvastatin attenuated TNF-α expression in the hippocampus of Aβ1-42-treated rats. The upper panel shows TNF-α-positive cells in the rat hippocampus, detected by immunohistochemistry on day 7 after Aβ injection (original magnification × 400). (A) Control group (Group 1); (B) atorvastatin control group (Group 2); (C) AD group (Group 3); and (D) atorvastatin-treated AD group (Group 4). (E) The lower panel shows the counted number of TNF-α-positive cells in rat hippocampus.
Notes: Data are the mean ± SD of each individuals. *P < 0.01.
Abbreviations: TNF-α, tumor necrosis factor alpha; Aβ, amyloid-beta (peptide); AD, Alzheimer’s disease.
Article
Amyloid-beta (Aβ) peptide is reported to initiate flexible inflammation in the hippocampus of the human brain in Alzheimer's disease (AD). The present study aimed to investigate the possible effects of atorvastatin on the production of inflammation cytokines in the hippocampus and the potential impacts on behavioral ability, in an AD model. We firstly established AD rat models using intracerebroventricular injection of Aβ1-42. A Morris water maze was also performed to determine the spatial learning and memory ability in the AD models. Intracellular staining of interleukin (IL)-1β, IL-6, and tumor necrosis factor alpha was determined using immunohistochemical staining at 6 hours and day 7 after the injection of Aβ. The escape latency of the atorvastatin-treated AD group (5 mg/kg/d) was significantly shorter than that of AD group on day 3 (41 ± 1.05 seconds versus 47 ± 1.05 seconds, P < 0.01) and day 4 (34 ± 1.25 seconds versus 43 ± 1.01 seconds, P < 0.01) after the beginning of the training. Furthermore, the atorvastatin-treated AD group displayed a significant higher mean number of annulus crossings than did the AD group (2.9 ± 0.5 versus 2.4 ± 0.9, P < 0.05). Fewer injured nerve cells and proliferated glial cells were also demonstrated in the atorvastatin-treated AD group than in the AD group. Of great importance, we demonstrated that IL-1β, IL-6, and tumor necrosis factor alpha were significantly decreased in the atorvastatin-treated AD group than that in the AD group. Atorvastatin might attenuate the damage of nerve cells and improve learning and memory ability by inhibiting inflammatory response in the progression of AD.
 
The cumulative incidence of the four types of orthopedic injury by age stratum and gender. (A) The cumulative incidence of the different types of orthopedic injury by age for males. (B) The cumulative incidence of the different types of orthopedic injury by age for females. Abbreviation: Fr, fractures. 
Characteristics of the enrolled subjects in 2004 
The incidences of various orthopedic injuries among CKD patients in Taiwan 
Probability of orthopedic fractures among patients with or without osteoporosis by gender and age group. 
Multiple regression models of orthopedic injury among the CKD population in Taiwan 
Article
The burden of chronic kidney disease (CKD) is a growing concern worldwide. The prevalence of hemodialysis in Taiwan is the highest in the world, and this may increase the prevalence of orthopedic fractures. The aim of this study was to explore the incidences of various orthopedic injuries and the related risk factors. A nationwide prospective study based on the Taiwan National Health Insurance dataset was conducted during 2004-2008. A total of 82,491 CKD patients were selected as the fixed cohort population. The International Classification of Diseases 9-CM diagnosis codes and treatment codes were identified as the inclusion criteria for orthopedic injury. A total of 82,491 Taiwanese people with CKD were identified in 2004, and 4915 orthopedic injuries occurred during the 5-year follow-up period. The cumulative incidences of orthopedic injuries were 42.56‰ for lower limb fractures, and 12.93‰, 3.27‰, and 1.64‰ for upper limb fractures, vertebrae fractures, and joint dislocations, respectively. All three types of orthopedic fractures were more common in the oldest age stratum (≥65 years old). In the CKD patients, the risk ratio of osteoporosis was 3.47 (95% confidence interval, 3.10-3.89) for all orthopedic injuries. Patients of advanced age, the female gender, and those with high comorbidity were also at significant risk of sustaining orthopedic fractures. The results from this Taiwanese CKD cohort support the strong influence of aging and osteoporosis on all kinds of orthopedic injuries. The postponing of osteoporosis may need to be taken into consideration for the prevention of orthopedic injury among CKD patients undergoing hemodialysis.
 
Descriptive characteristic of participants 
Wilcoxon paired-samples test (muscle perimeters) 
Wilcoxon test for repeated measures (skinfold thickness) 
Wilcoxon test of bone diameters 
Article
The purpose of this study was to examine the differences in anthropometric measurements using an aerobic and Pilates exercise program which lasted 24 weeks. This was a clinical intervention study of 303 women over the age of 60 living in Novi Sad, Serbia. Changes in body mass index and skinfold thickness were estimated through height, weight, and anthropometric measurements. The program comprised Pilates exercises for upper- and lower-body strength, agility, and aerobic capacity. Fat mass (FM) improved significantly (pre-test, 32.89%, 8.65; post-test, 28.25%, 6.58; P<0.01). Bone diameters and muscle perimeters showed no significant changes pre- and post-test (P>0.05), but there was a higher correlation between FM (%) and waist-hip ratio (rho, 0.80; P<0.01). A mixed program of aerobics and Pilates, controls and improves baseline muscle mass and decreases FM values, without causing deterioration during practice and follow-up exercises.
 
Article
Anne WS Rutjes,1 Marcello Di Nisio2,31Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; 2Department of Medical, Oral, and Biotechnological Sciences, University G D'Annunzio of Chieti-Pescara, Chieti, Italy; 3Department of Vascular Medicine, Academic Medical Center, Amsterdam, the NetherlandsWe read with interest the article by Ruiz-Montero et al, in which the authors used a before-and-after study design to examine changes in body composition (fat mass and lean body mass) related to an aerobic-Pilates program in elderly Serbian women.1 The authors concluded that "a combined program of aerobic and Pilates, carried out under the supervision of an instructor, at least twice a week, produces health benefits in functionally independent women over the age of 60". This conclusion is overly optimistic and not supported by the evidence provided. View original paper by Ruiz-Montero and colleagues.
 
Ages levels in normal controls and critically ill patients. Note: *P,0.001. Abbreviations: Ages, advanced glycation end products; ICU, intensive care unit. 
srAge levels in critically ill patients and normal controls. Note: *P,0.001. Abbreviations: srAge, soluble receptor for advanced glycation end products; ICU, intensive care unit. 
Correlations between srAge levels and other clinical markers among critically ill patients 
Association of srAge levels and clinical markers with prognosis in critically ill patients 
Article
To investigate the possible associations between serum levels of soluble receptor for advanced glycation end products (sRAGE) and specific clinical markers and prognosis in critically ill patients diagnosed with stress hyperglycemia. A total of 70 critically ill patients and 25 normal controls were recruited for this study. Serum levels of sRAGE and advanced glycation end products (AGEs) were determined using enzyme-linked immunosorbent assay. Additional data on other clinical markers were obtained from patient records in the intensive care unit. Comparisons of sRAGE and AGEs levels between groups were assessed by t-test. The relationships between sRAGE and other clinical markers were assessed by Pearson's correlation analyses and multiple linear regression analyses. Risk factors for prognosis, such as 28-day mortality were analyzed using logistic regression analysis. Serum sRAGE and AGEs levels were significantly higher in critically ill patients, compared to normal controls (P<0.05). The increase in serum sRAGE levels was significantly correlated with AGEs levels, interleukin-6 levels, and the sequential organ failure assessment score (P<0.01). Using multiple linear regression analysis, the association between AGEs and sRAGE remained significant after adjustment of other clinical factors. However, there were no significant correlations between sRAGE levels and patient outcome in these critically ill patients. Serum sRAGE levels were significantly elevated in critically ill patients and positively correlated with higher AGEs levels, but sRAGE levels were not associated with increased mortality, suggesting sRAGE levels are not a predictor of prognosis in critically ill patients.
 
Percentage of patients receiving treatment as a function of average cumulative volume of injected product per treatment period and corresponding average level of improvement from baseline, as measured by the Wrinkle Severity Rating Scale (WSRS). 
Degree of satisfaction of treatment effects according to study subjects' self-assessment (%). 
A 48-year-old female (Wrinkle Severity Rating Scale grade 3) before and after application of 0.6 mL/side of cross-linked carboxymethyl cellulose and reapplication of 0.5 mL/side at Month 9. Notes: (A) Before treatment; (B) Month 3; (C) Month 6; (D) Month 9 before reapplication; (E) Month 9 after reapplication; (F) Month 12; (G) Month 18. 
Intensity and duration of adverse events in those who suffered from them 
Article
In recent years there has been a growing interest in nonsurgical procedures for facial rejuvenation. Hyaluronic acid is currently the most widely used dermal filler for the treatment of facial wrinkles. However, new products with interesting features are being introduced into the market. Cross-linked carboxymethylcellulose is one of these and represents a new alternative for the correction of wrinkles and facial defects. The retrospective, multicenter, open-label study on nasolabial folds reported here was carried out between January 2010 and April 2014 on 350 subjects between 22 and 67 years of age for a 36-month follow-up period in order to consistently and extensively assess the safety and performance of this treatment. The study revealed effective and durable correction of nasolabial wrinkles for periods of 9-12 months. Product reapplication over a 36-month period did not lead to an increase in adverse effects, which always remained rare and of little clinical significance, usually consisting of bruising and redness. Cross-linked carboxymethyl cellulose has been shown to be a safe and effective alternative to the resorbable products currently on the market.
 
Patient demographics 
Qmax and PVR of the 2 groups before and 12 weeks after operation 
SF-36 scores before the operation 
SF-36 scores of the two groups 12 weeks after operation 
Article
We used the Short Form (SF)-36® Health Survey scale to assess the effect of pelvic floor muscle exercise (PFE) on aging males who received transurethral resection of the prostate (TUR-P). From April 2010 to December 2010, a total of 66 patients who underwent TUR-P were enrolled in this study. They were randomized into two groups (with 33 patients in each group) - an experimental group who performed postoperative PFE every day and a control group. Data, including the International Prostate Symptom Score (IPSS), uroflowmetry study, and the SF-36 quality of life measure, were collected before the operation, and at 1, 4, 8, and 12 weeks after the operation. We analyzed the differences between the two groups with respect to their IPSS scores, maximal urinary flow rate, residual urine amount, and life quality. A total of 61 patients (experimental group: 32 patients, and control group: 29 patients) completed this study. We found that at 12 weeks postop, patients who performed PFE every day had a better maximal urinary flow rate (16.41 ± 6.20 vs 12.41 ± 7.28 mL/min) (P = 0.026) compared with patients in the control group. The experimental group had a much greater decrease in IPSS score (P < 0.001). As for the SF-36 scale, the experimental group had higher scores than did the control group on both the physiological domain (54.86 vs 49.86) (P = 0.029) and the psychological domain (61.88 vs 52.69) (P = 0.005). However, there were no significant differences with respect to the postvoiding residual urine between the two groups (57.24 ± 52.95 vs 64.68 ± 50.63 mL) (P = 0.618). Compared with the control group, patients who performed PFE for 12 weeks after TUR-P showed improvement in their maximal urinary flow rate and lower urinary tract symptoms, and had a better quality of life. The immediate initiation of PFE is suggested for patients who undergo TUR-P.
 
Article
A three-dimensional (3D) continuous pulse arterial spin labeling (ASL) technique was used to investigate cerebral blood flow (CBF) changes in patients with Alzheimer's disease (AD), amnestic mild cognitive impairment (aMCI), and age- and sex-matched healthy controls. Three groups were recruited for comparison, 24 AD patients, 17 MCI patients, and 21 age- and sex-matched control subjects. Three-dimensional ASL scans covering the entire brain were acquired with a 3.0 T magnetic resonance scanner. Spatial processing was performed with statistical parametric mapping 8. A second-level one-way analysis of variance analysis (threshold at P<0.05) was performed on the preprocessed ASL data. An average whole-brain CBF for each subject was also included as group-level covariates for the perfusion data, to control for individual CBF variations. Significantly increased CBF was detected in bilateral frontal lobes and right temporal subgyral regions in aMCI compared with controls. When comparing AD with aMCI, the major hyperperfusion regions were the right limbic lobe and basal ganglia regions, including the putamen, caudate, lentiform nucleus, and thalamus, and hypoperfusion was found in the left medial frontal lobe, parietal cortex, the right middle temporo-occipital lobe, and particularly, the left anterior cingulate gyrus. We also found decreased CBF in the bilateral temporo-parieto-occipital cortices and left limbic lobe in AD patients, relative to the control group. aMCI subjects showed decreased blood flow in the left occipital lobe, bilateral inferior temporal cortex, and right middle temporal cortex. Our results indicated that ASL provided useful perfusion information in AD disease and may be used as an appealing alternative for further pathologic and neuropsychological studies, especially of compensatory mechanisms for cerebral hypoperfusion.
 
Article
Innovative Vision Products, Inc. (IVP)'s scientists developed the lubricant eye drops (Can-C) designed as 1% N-acetylcarnosine (NAC) prodrug of L-carnosine containing a mucoadhesive cellulose-based compound combined with corneal absorption promoters in a sustained drug delivery system. Only the natural L-isomeric form of NAC raw material was specifically synthesized at the cGMP facility and employed for the manufacturing of Can-C eye drops. In the present clinical study the authors assessed vision before and after 9 month term of topical ocular administration of NAC lubricant eye drops or placebo in 75 symptomatic patients with age-related uncomplicated cataracts in one or both eyes, with acuity in one eye of 20/40 or worse (best-corrected distance), and no previous cataract surgery in either eye and no other ocular abnormality and 72 noncataract subjects ranged in age from 54 to 78 years. Subjects in these subsample groups have reported complaints of glare and wanted to administer eye drops to get quick eye relief and quality of vision for their daily activities including driving and computer works. Following 9 months of treatment with NAC lubricant eye drops, most patients' glare scores were improved or returned to normal in disability glare tests with Halometer DG. Improvement in disability glare was accompanied with independent improvement in acuity. Furthermore, patients with the poorest pretreatment vision were as likely to regain certain better visual function after 9 months of treatment with N-acetylcarnosine lubricant eye drops as those with the worth pretreatment vision. The authors made a reference to electronic records of the product sales to patients who have been made the repurchase of the Can-C eye drops since December 2001. Based on this analysis of recorded adjustments to inventory, various parameters were analyzed during the continued repurchase behavior program, including testimonials from buyers. With these figures, researchers judged on the patients' compliance rate to self-administer NAC eye-drops. The ophthalmic drug showed potential for the non-surgical treatment of age-related cataracts for participants after controlling for age, gender and daily activities and on a combined basis of repurchases behavior reports in more than 50,000 various cohort survivors, has been demonstrated to have a high efficacy and good tolerability for prevention and treatment of visual impairment determined for the older population with relative stable pattern of causes for blindness and visual impairment. The mechanisms of prevention and reversal of cataracts with NAC ophthalmic drug are considered which include prevention by the intraocular released carnosine of free-radical-induced inactivation of proprietary lens antioxidant enzymes (superoxide dismutase); prevention of carbohydrate and metal-catalyzed autooxidation of ascorbic acid-induced cross-linking glycation reactions to the lens proteins; transglycation properties of carnosine, allowing it to compete for the glycating agent, protecting proteins (lens crystallins) against modification; universal antioxidant and scavenging activity towards lipid hydroperoxides, aldehydes and oxygen radicals; activation with l-carnosine ingredient of proteasome activity in the lens; chaperone-like disaggregating to lens crystallins activity of NAC and of its bioactivated principal carnosine. Blindness incidence increased with advancing age, such as cataract and glaucoma, which are by far the commonest causes of blindness in our sample and in all age groups, glaucomatous neurodegeneration can be treated with developed NAC autoinduction prodrug eye drops equipped with corneal absorption promoters. The common blinding affections presenting in developed countries such as, senile macular degeneration, hereditary chorioretinal dystrophies, diabetic retinopathy are poorly represented in our current summary of vital-statistics and will be reported inherent in next N-acetylcarnosine ophthalmic drug studies. The authors present evidence, about why only a certain kind of NAC is safe, and why only certain formulas designed by IVP for drug discovery are efficacious in the prevention and treatment of senile cataract for long-term use. Overall cumulated studies demonstrate that the designed by IVP new vision-saving drug NAC eye drops help the aging eye to recover by improving its clarity, glare sensitivity, color perception and overall vision.
 
(A) Histopathological analysis of cervical tissue. Nests of neoplastic squamous cells are invading the stroma (arrow head). The cancer is poorly differentiated and keratinizing (original magnification ×200). (B) Pelvic lymph node. Metastatic cells from squamous cell carcinoma (black square) are surrounded by normal lymphocytes (original magnification ×200).
Bladder cytological sample, showing the presence of malignant squamous cells (black arrow) as extrinsic infiltration from cervical carcinoma (original magnification ×200).
Real-time PCR performed on cervical cancer cells.
Notes: Anyplex™ II HPV28 detection (Seegene Inc., Seoul, Korea) assay simultaneously detects 28 HPV genotypes. The picture shows the appearance of the higher melting peaks. The Probe A peak demonstrates amplification of plasmid DNA, which is considered to be the positive internal control. The Probe B peak demonstrates the amplification of HPV-53 detected within the cervical cancer cells. –d(RFU)/dT: post-amplification melt-curve analysis, performed by plotting the negative value of the change in rate of fluorescence units against temperature.
Abbreviations: DNA, deoxyribonucleic acid; HPV, human papilloma virus; PCR, polymerase chain reaction.
Article
The introduction of organized cervical cancer (CC) screening programs has drastically reduced the prevalence of CC. However the incidence is still too high, especially among elderly women. All guidelines strongly recommend a regular Papanicolaou (Pap) testing for young and middle-aged patients. On the other hand, many international professional societies no longer advise screening in women who have undergone hysterectomy, and in women aged 65 years and above, who have a previous history of regular Pap smears. Here we report the case of poorly differentiated CC, involving the pelvic lymph nodes and urinary bladder, occurring in a 79-year-old woman who regularly underwent Pap tests, with no reported cytological abnormalities. In this very rare case, the CC cells, as well as cells from metastatic lymph nodes and cells from urinary specimens, molecularly showed human papilloma virus (HPV)-53. With the limitations of a single case, this report brings important information to prevent CC in elderly patients: the utility of molecular tests to increase sensitivity of Pap smears in postmenopausal women; the importance of HPV-53 as one of the four "emergent" genotypes having a possible role in oncogenesis; and the presence of HPV-53 in lymph node metastases from cervical carcinoma, which would support the role of this virus in the maintenance of malignant status.
 
Article
Zappacosta et al1 recently published a case report concerning a human papillomavirus (HPV)-positive invasive cervical cancer in a 79-year-old women who had a history of normal Pap smears. In this article, Anyplex II HPV28 (Seegene) is used for HPV genotyping of formalin-fixed paraffin embedded (FFPE) tissue, liquid based cytology (LBC) specimens and urine samples. It is suggested that HPV53 is present exclusively in the cervical cancer cells, lymph node metastases, and atypical urinary cells of one single case while the surrounding CIN2+ tissue revealed ten different HPV strains. Unfortunately, the HPV genotype results for lymph nodes and urinary cells are not presented while these results underline the potential role of HPV53 in oncogenesis. Moreover, it is generally accepted that one lesion is caused by one HPV infection, detection of multiple HPV types thus indicates the presence of multiple infections,2 suggesting that this patient may have several lesions.
 
The exact Hounsfield unit statistic measurements were obtained from the apexes of incisors (central and lateral), the apex of canine tooth, the apex of premolars, the apex of molars, and the region of tuber maxilla. These regions of measurements are shown on the figure as 1.8 mm 2 colorful square points. Abbreviations: HU, Hounsfield units; SD, standard deviation. 
Article
In this study, we investigated the effects of long-term antihypertensive treatment with calcium channel blockers or beta blockers on the bone mineral density of maxilla, as determined by cone-beam computed tomography (CBCT). This retrospective study was conducted on CBCT images of men older than 55 years who had received different dental indications. Data were grouped into three categories according to the antihypertensive medication history of the patients: group A included patients who had been taking beta-blocker treatment for more than 5 years, group B included patients who had been taking calcium channel blocker treatment for more than 5 years, and the control group included patients who had never used any hypertensive medications before. Statistically significant differences were observed between the beta blocker and calcium channel blocker groups. In hypertension treatment, beta blockers may be preferred to calcium channel blockers in patients at high risk for osteoporosis and bone resorption.
 
Article
It is unclear whether physical activity in later life is beneficial for maintenance of cognitive function. We performed a systematic review examining the effects of exercise on cognitive function in older individuals, and present possible mechanisms whereby physical activity may improve cognition. Sources consisted of PubMed, Medline, CINAHL, the Cochrane Controlled Trials Register, and the University of Washington, School of Medicine Library Database, with a search conducted on August 15, 2012 for publications limited to the English language starting January 1, 2000. Randomized controlled trials including at least 30 participants and lasting at least 6 months, and all observational studies including a minimum of 100 participants for one year, were evaluated. All subjects included were at least 60 years of age. Twenty-seven studies met the inclusion criteria. Twenty-six studies reported a positive correlation between physical activity and maintenance or enhancement of cognitive function. Five studies reported a dose-response relationship between physical activity and cognition. One study showed a nonsignificant correlation. The preponderance of evidence suggests that physical activity is beneficial for cognitive function in the elderly. However, the majority of the evidence is of medium quality with a moderate risk of bias. Larger randomized controlled trials are needed to clarify the association between exercise and cognitive function and to determine which types of exercise have the greatest benefit on specific cognitive domains. Despite these caveats, the current evidence suggests that physical activity may help to improve cognitive function and, consequently, delay the progression of cognitive impairment in the elderly.
 
Prevalence of SBI
Magnetic resonance imaging from patients with silent brain infarctions and Virchow-Robin spaces: (A) several silent brain infarctions (arrow) in the axial image of the FLAIR sequence; (B–D) numerous Virchow-Robin spaces in the basal ganglia (circle) in the FLAIR axial, T2-weighted axial, and T1-weighted saggital images.
Distribution of SBI.
Note: Distribution of the silent brain infarctions is described in the diagram. The number of vertical lines denotes the frequencies (percent) of corresponding lesions.
Abbreviations: SBI, silent brain infarction; ref, references.
Article
With the increasing size of the elderly population and evolving imaging technology, silent brain infarction (SBI) has garnered attention from both the public and the physicians. Over 20% of the elderly exhibit SBI, and the prevalence of SBI increases steadily with age, ie, 30%-40% in those older than 70 years. Well-known cardiovascular risk factors such as hypertension has been identified as a risk factor of SBI (odds ratio [OR] = 3.47) Besides this, blood pressure (BP) reactivity to mental stress, morning BP surges, and orthostatic BP changes have been demonstrated to contribute to the presence of SBI. Further, a metabolic syndrome not only as a whole syndrome (OR =2.18) but also as individual components could have an influence on SBI. Increased C-reactive protein and interleukin-6, coronary artery disease, body mass index, and alcohol consumption have also been associated with SBI. The ORs and possible mechanisms have been discussed in this article. Overt stroke, dementia, depression, and aspiration pneumonia were all associated with SBI. (overt stroke: hazard ratio [HR] =1.9, 95% confidence interval [CI]: 1.2-2.8; dementia: HR =2.26, 95% CI: 1.09-4.70). We also looked into their close relationship with SBI in this review.
 
Characteristics of the sample (percent by leisure-time physical activity)
Regression analysis dependent variable: short mental state examination (age 60-69 years)
Mean short mental state examination (SMSE) score by physical activity and apolipoprotein E genotype (age 60 to 69 years).
Mean short mental state examination (SMSE) score by leisure-time physical activity and apolipoprotein E genotype (age ≥ 70 years).
Article
To test the hypothesis that aerobic-related leisure-time physical activity (PA) is associated with better cognitive function and that the effect varies among apolipoprotein E (APOE) genotype groups. Cross-sectional study of persons examined in the Third National Health and Nutrition Examination Survey (NHANES-III; 1988-1994). US noninstitutionalized population. From a sample of 7159, aged ≥60 years, we analyzed data for 1799 older American men and women who had information on PA, a short mental status examination (SMSE), and were genotyped at the apolipoprotein E gene locus. In the initial bivariate analysis, non-ɛ4 carriers and ɛ4-heterozygotes performed better than ɛ4-homozygotes in the 60-69 age group. After controlling for multiple confounders including mobility limitation, PA correlated with a higher SMSE score in non-ɛ4 carriers (P = 0.014), but not in ɛ4 carriers (P = 0.887). At ≥70 years, PA also correlated with higher adjusted SMSE scores in non-ɛ4 carriers (P = 0.02); but this association became nonsignificant after controlling for mobility limitation (P = 0.12). In a nationally representative sample, PA was associated with enhanced cognition, an effect that was differentially influenced by apolipoprotein E genotype. Experimental studies are needed to determine whether or not PA can attenuate cognitive decline.
 
Pivotal phase III Studies (24 Weeks) of saxagliptin in patients with type 2 diabetes mellitus 
Article
To assess safety and efficacy of saxagliptin in older patients with type 2 diabetes mellitus (T2DM). This was a post hoc analysis of pooled data from older patients (≥65 years of age) from five 24-week phase III trials: three studies of saxagliptin versus placebo as an add-on therapy to metformin, glyburide, or a thiazolidinedione; and two studies of saxagliptin versus placebo as monotherapy in drug-naïve patients. Separate analyses were conducted on one study of initial combination therapy with saxagliptin plus metformin versus metformin monotherapy in drug-naïve patients. The safety analysis population for the five-study pool included 428 patients ≥ 65 years of age with baseline glycated hemoglobin (HbA1c) 7.0% to 10.5% who received saxagliptin 2.5 or 5 mg or placebo, and for the study of initial combination therapy included 69 patients ≥ 65 years of age with baseline HbA1c 8.0% to 12.0% who received saxagliptin 5 mg in combination with metformin or metformin monotherapy. The primary efficacy endpoint was change from baseline HbA1c. In the five-study pool, the differences in the adjusted mean change from baseline HbA1c among older patients receiving saxagliptin versus placebo were -0.60% (95% confidence interval [CI], -0.99% to -0.21%) for saxagliptin 2.5 mg and -0.55% (-0.97% to -0.14%) for saxagliptin 5 mg; in the initial combination study, the difference was -1.22% (-2.27% to -0.17%) among older patients receiving saxagliptin 5 mg plus metformin versus metformin monotherapy. The results were generally similar in older and younger patients. Saxagliptin was well tolerated; the incidence and types of adverse events were similar for saxagliptin and comparators. Hypoglycemia was reported in 3.0% to 9.4% of patients receiving saxagliptin (0%-8.0% for comparators) and was confirmed (finger stick glucose ≤ 50 mg/dL, with associated symptoms) in 0% to 0.7% (0%-0.7% for comparators); hypoglycemic episodes did not vary by age category and did not require medical intervention. Saxagliptin was effective and well tolerated, with a low risk of hypoglycemia, when used as monotherapy, add-on therapy, or initial combination therapy with metformin in older patients with T2DM.
 
Twenty-eight-day mortality according to stratification of vancomycin trough concentrations and AUC values. Data were presented as percentages. P values were determined by χ 2 tests. Stratification of vancomycin trough concentrations revealed no statistically significant relationship with 28-day mortality at any of the breakpoints evaluated (P = 0.603 [A]). however, AUC values of 250-350 µg*h/ml and 350-450 µg*h/mL were associated with significantly lower 28-day mortality than AUC values ,250 and .450 µg*h/ml (P , 0.001 [B]). Abbreviation: AUC, area under the concentration curve. 
Characteristics of study patients with methicillin-resistant Staphylococcus aureus pneumonia 
Pharmacokinetic and pharmacodynamic parameters for vancomycin between surviving and nonsurviving patients with methicillin-resistant Staphylococcus aureus pneumonia 
risk factors for mortality after treatment of methicillin-resistant Staphylococcus aureus pneumonia with vancomycin 
Adverse effects of vancomycin among survivors and nonsurvivors 
Article
Methicillin-resistant Staphylococcus aureus (MRSA) infections are associated with significant mortality and health care costs. To improve treatment outcomes for MRSA, a better understanding of the pharmacokinetic/pharmacodynamic parameters of vancomycin is required to develop optimal dosing strategies, particularly in elderly patients (≥75 years of age) with limited renal function. The purpose of this study was to determine whether pharmacokinetic indices for vancomycin are associated with mortality from MRSA hospital-acquired pneumonia in elderly patients. We conducted a retrospective observational study with 28-day mortality as the primary outcome for 94 patients with MRSA hospital-acquired pneumonia who had been treated with vancomycin from January 2006 through December 2012. Our most recent sampling of MRSA isolates had a minimum inhibitory concentration (MIC) for vancomycin of 1 μg/mL (86%), indicating that the area under the curve (AUC) was equal to the AUC/MIC in these isolates. The primary data from 28-day survivors and nonsurvivors were compared. Among 94 elderly patients, the mean age was 82 (75-99) years. Multivariate analyses revealed that, among the factors examined, only the nonoptimal AUC (<250, >450 μg*h/mL) was an independent predictor of 28-day mortality in elderly patients (odds ratio 23.156, 95% confidence interval 6.814-78.687, P < 0.001). We detected a significant difference for increasing nephrotoxicity in nonsurvivors (nine of 32 patients [28%]) compared with survivors (three of 62 patients [4.8%], P = 0.003). This finding indicates that patients with potentially poor renal function are likely to have increased AUC values and a poor prognosis. Consideration of the pharmacokinetics/pharmacodynamics of vancomycin and targeting an AUC/MIC value of 250-450 μg*h/mL may result in improved treatment outcomes for elderly patients with MRSA hospital-acquired pneumonia.
 
Unadjusted mean of MMse as a function of falls over 6 years. Abbreviations: CI, confidence interval; MMSE, Mini-Mental Status Examination.  
Adjusted mean of MMse as a function of falls over 6 years. Abbreviations: CI, confidence interval; MMSE, Mini-Mental Status Examination.  
general linear mixed model estimates for MMse score as a function of falls over 6-year period among older Mexican Americans
Article
Little is known about long-term emotional and cognitive consequences of falls. We examined the association between falls and subsequent cognitive decline, and tested the hypothesis that depression would mediate any falls-cognition association among cognitively intact Hispanic Elders. We used data from the Hispanic Established Population for the Epidemiological Study of the Elderly to examine change in Mini Mental State Examination (MMSE) scores over the 6-year period according to number of falls. All participants (N=1,119) had MMSE scores ≥21 and complete data on Center for Epidemiologic Studies of Depression Scale, social and demographic factors, medical conditions (diabetes, heart attack, stroke, and hypertension), and hand grip muscle strength. At baseline, participants' mean age was 80.8 years (range, 74-109), mean education was 6.3 years (range, 0-17), and mean MMSE was 25.2 (range, 21-30). Of the 1,119 participants, 15.8% experienced one fall and 14.4% had two or more falls. In mixed model analyses, having two or more falls was associated with greater decline in MMSE score (estimate =-0.81, standard error =0.19, P<0.0001) compared to having no fall, after adjusting for age, sex, marital status, and education. The magnitude of the association decreased (estimate =-0.65, standard error =0.19, P=0.0007) when adjustment was made for high depressive symptoms, suggesting a possible mediating effect of depression on the falls-cognition association. Female sex, high level of education, and high performance in hand grip muscle strength were associated with a slower decline in MMSE scores. Having two or more falls was independently associated with steeper decline in cognition over 6 years, with a possible mediating effect of depression on the falls-cognition association.
 
Article
Background This study aimed to investigate whether there were sex differences in in-hospital and long-term outcomes for elderly patients over 75 years of age undergoing percutaneous coronary intervention for coronary heart disease. Methods Consecutive patients aged ≥75 years who underwent percutaneous coronary intervention at a single center in the People’s Republic of China from January 2005 to December 2010 were included in this cohort study. Clinical characteristics and in-hospital and long-term outcomes were compared between men and women. Results A total of 465 patients (34.8% women, mean age 78.5±3.2 years) were recruited. Men had a higher prevalence of ST elevation myocardial infarction but were less likely to have heart failure than women (P<0.05). Similar rates of successful in-hospital procedures and deaths were observed in men and women. After a mean follow-up of 3 years, no significant differences were observed between men and women in mortality (12.5% versus 8.0%, P=0.151), myocardial infarction (1.4% versus 2.7%, P=0.368), target vessel revascularization (6.1% versus 4.7%, P=0.540), or cerebral vascular disease (7.9% versus 6.0%, P=0.472). Cox proportional hazards analysis revealed that sex was not independently associated with either in-hospital mortality or long-term mortality. Conclusion In elderly patients over 75 years of age, sex influences the prognosis after percutaneous coronary intervention for coronary heart disease.
 
Flow diagram of design and participants in the intervention study.
Comparison between intervention group and control group at baseline
Measured variables in intervention group and control group at baseline and after intervention 
Article
The aim of this study was to evaluate the effects of a telephone-based self-care intervention among urban living individuals 75+ years of age by comparing self-reported perceived health, mental health, sense of coherence, self-care ability, and self-care agency before and after the intervention. In a randomized controlled study, 15 persons answered a questionnaire about perceived health, mental health, sense of coherence, self-care ability, and self-care agency. In a sex- and age-matched control group (n=15), the same questions were answered. Data were collected before and after intervention. An open-ended question about experiences of the intervention was included in the last questionnaire. The intervention consisted of a first meeting with health professionals and additional five self-care telephone calls. The control group did not receive any intervention or attention except for the questionnaires. Descriptive statistics were used to describe the study group. To compare the intervention group and control group on nominal and ordinal levels, the McNemar test and the Wilcoxon signed-rank test, respectively, were chosen. Thirty individuals (14 females and 16 males) participated in the study, ranging in age between 75 and 93 years. A significant difference was obtained in the intervention group regarding mental health. Mental health improved significantly in the intervention group (P=0.037). In the control group, mental health, sense of coherence, self-care ability, and self-care agency showed worse outcome results after the intervention (19 weeks). Self-care telephone talks improved mental health significantly in our sample, and mental health focus could be understood as a possible condition for health promotion to take place. Structured self-care telephone talks have proved to be successful and a relevant method to use in practice.
 
Characteristics of included clinical trial populations 
Baseline scores 
Clinically relevant response. Notes: (A) Odds ratios for improvement in cognition (at least 3 points in the SKT or at least 4 points on the ADAS-cog). (B) Odds ratios for improvement in CGIC and ADCS-CGIC. Abbreviations: EGb, EGb 761 ® ; CGIC, Clinical Global Impression of Change; ADAS-cog, cognitive subscale of the Alzheimer's Disease Assessment Scale; ADCS-CGIC, Alzheimer's Disease Cooperative Study Clinical Global Impression of Change; CI, confidence interval; M-H, Mantel-Haenszel test; SKT, Short Cognitive Performance Test (Syndrom-Kurztest). 
Article
The objective of this systematic review was to evaluate current evidence for the efficacy of Ginkgo biloba extract EGb 761(®) in dementia. Seven of 15 randomized, placebocontrolled trials in patients with dementia identified by database searches met all our selection criteria and were included in the meta-analysis. In these trials, patients were treated with 120 mg or 240 mg per day of the defined extract EGb 761 or placebo. Efficacy was assessed using validated tests and rating scales for the cognitive domain, the functional domain (activities of daily living), and global assessment. Tolerability was evaluated by risk differences based on incidences of adverse events and premature discontinuation rates. Of 2,684 outpatients randomized to receive treatment for 22-26 weeks, 2,625 represented the full analysis sets (1,396 for EGb 761 and 1,229 for placebo). Standardized mean differences for change in cognition (-0.52; 95% confidence interval [CI] -0.98, -0.05; P=0.03), activities of daily living (-0.44; 95% CI -0.68, -0.19; P<0.001), and global rating (-0.52; 95% CI -0.92, -0.12; P=0.01) significantly favored EGb 761 compared with placebo. Statistically significant superiority of EGb 761 over placebo was confirmed by responder analyses as well as for patients suffering from dementia with neuropsychiatric symptoms. Treatment-associated risks in terms of relative risks of adverse events and premature withdrawal rates did not differ noticeably between the two treatment groups. In conclusion, meta-analyses confirmed the efficacy and good tolerability of Ginkgo biloba extract EGb 761 in patients with dementia.
 
Article
The number of elderly patients with chronic kidney disease (CKD) stage 5 management with hemodialysis (HD) is steadily increasing. Therefore we analyzed the number of new CKD patients ≥80 years managed with HD and their survival through the study period. We aimed also, to identify which of several key variables might be independently associated with survival in this very elderly population of patients. This was a single-center, retrospective cohort study that took place during the period from January 1987 to September 2012. The study consisted of 78 (50 male and 28 women) very elderly patients (≥80 years of age); the mean age at which HD was initiated was 83.2±2.5 years. Survival and factors associated with mortality were studied. Survival was defined as the time from start of HD treatment to death (or end of study, if still alive). In the period from 1987 to 2002, patients ≥80 years of age were only sporadically treated with HD, but since 2003, the number of new patients has been steadily increasing. The mean survival for our group of patients was 25.1±22.4 months (range 1-115 months). Furthermore, 30.8% patients survived <12 months, 29.5% patients survived 12-24 months, 30.8% patients survived 24-60 months, and 9% patients survived >60 months on HD treatment. Older patients were less likely to have diabetes, and primary renal disease did not influence survival. Patients with high C-reactive protein levels and poor nutritional status, as well as those who did not have pre-HD nephrology care and those that had a catheter as vascular access for HD had poor survival. In about half of our patients, the cause of death was cardiovascular disease. Among patients who were ≥80 years of age at the start of HD treatment, those who received pre-HD nephrology care that followed a planned management pathway, those who had a good nutritional status, and those with an arteriovenous fistula as vascular access for HD at the time of HD initiation had a better survival.
 
New vertebral fractures in PTH and Pcb groups. TOP study. Abbreviations: Pcb, placebo; PTH, parathyroid hormone; TOP, treatment of osteoporosis with parathyroid hormone.
Number (left) and severity (right) of new fractures in PTH and Pcb groups. TOP study. Abbreviations: Pcb, placebo; PTH, parathyroid hormone; TOP, treatment of osteoporosis with parathyroid hormone. 
Changes in bone turnover markers (formation: N-propeptide of type I collagen [PINP], bone specifi c alkaline phosphatase [BALP]; resorption: serum C-terminal telopeptide of type I collagen [sCTX]) during one year of therapy with PTH. TOP study. Abbreviations: PTH, parathyroid hormone; TOP, treatment of osteoporosis with parathyroid hormone.
Article
To review the pharmacological properties and the available clinical data of full length parathyroid hormone (PTH) in post-menopausal osteoporosis. A MEDLINE search was completed, together with a review of information obtained from the manufacturer and from the medicine regulatory agencies. STUDY AND DATA SELECTION: Studies were selected according to relevance and availability. Relevant information (design, objectives, patients' characteristics, outcomes, adverse events, dosing, etc) was analyzed. Different studies have shown that, when administered intermittently as a subcutaneous injection in the abdomen, PTH increases bone mineral density (BMD) and prevents vertebral fractures. On completion of PTH therapy (up to 24 months), there is evidence that sequential treatment with alendronate is associated with a therapeutic benefit in terms of increase in BMD. Further trials are necessary to determine long-term safety and the role of PTH in combination with other treatments for osteoporosis and the effect of repeated cycles of PTH followed by an anti-catabolic agent. There are currently no completed comparative trials with other osteoporosis treatments. Full length PTH, given intermittently as an abdominal subcutaneous injection, appears to be a safe and efficacious treatment option for high risk osteoporosis. More data are needed to determine its specific role in osteoporosis treatment.
 
Baseline characteristics of the 205 elderly participants with different cognitive function levels grouped by MMse scores 
Article
The relationship between mortality and impaired cognitive function has not been thoroughly investigated in a very elderly community-dwelling population, and little is known about the association of disease-specific mortality with Mini-Mental State Examination (MMSE) subscale scores. Here we evaluated these data in Japanese community-dwelling elderly. In 2003, 85 year-olds (n=207) were enrolled; 205 completed the MMSE for cognitive function and were followed-up for 10 years, during which time 120 participants died, 70 survived, and 17 were lost to follow-up. Thirty-eight deaths were due to cardiovascular disease, 22 to senility, 21 to respiratory disease, and 16 to cancer. All-cause mortality decreased by 4.3% with a 1-point increase in the global MMSE score without adjustment, and it decreased by 6.3% with adjustment for both sex and length of education. Cardiovascular mortality decreased by 7.6% and senility mortality decreased by 9.2% with a 1-point increase in the global MMSE score with adjustment for sex and education. No association was found between respiratory diseases or cancer mortality and global MMSE score. All-cause mortality also decreased with increases in MMSE subscale scores for time orientation, place orientation, delayed recall, naming objects, and listening and obeying. Cardiovascular mortality was also associated with the MMSE subscale of naming objects, and senility mortality was associated with the subscales of time orientation and place orientation. Thus, we found that impaired cognitive function determined by global MMSE score and some MMSE subscale scores were independent predictors of all-cause mortality or mortality due to cardiovascular disease or senility in 85 year-olds.
 
Baseline characteristics of the participants with different serum concentrations of TC
Baseline characteristics of participants who survived or did not survive during the 10-year follow-up period
Survival curves of the participants who survived during the 10-year follow-up period among the three total cholesterol (TC) groups: for all participants (A), for men (B), and for women (C).
Cox analyses of the high-TC, intermediate- TC, and low-TC groups for total mortality without adjustment; with adjustment only for gender; and with adjustment for gender, smoking, alcohol intake, history of stroke or heart disease, serum albumin concentration, BMI, and systolic BP
Article
Little is known about the association between total cholesterol (TC) and all-cause mortality in the elderly (especially the very elderly). Here we examined the association between TC and all-cause mortality in 207 very elderly (85-year-old) participants. In 2003, we performed a baseline laboratory blood examination, and blood pressure (BP) and body mass index (BMI) measurements, and lifestyle questionnaires were completed by the participants. The participants were followed for the subsequent 10 years. As of 2013, of the 207 participants in 2003, 70 participants had survived, 120 individuals had died, and 17 were lost to follow up. The TC values were divided into high-TC (≥209 mg/dL), intermediate-TC (176-208 mg/dL), and low-TC (≤175 mg/dL) categories. With the Kaplan-Meier method, we found that both the high-TC and intermediate-TC participants survived longer than the low-TC participants. The men with high TC survived longer than those with low TC, but no corresponding difference was found for the women. A multivariate Cox proportional hazards regression model, with adjustment for gender, smoking, alcohol intake, history of stroke or heart disease, serum albumin concentration, BMI, and systolic BP, revealed that the total mortality in the low-TC group was 1.7-fold higher than that in the high-TC group. Mortality, adjusted for the same factors, decreased 0.9% with each 1 mg/dL increase in the serum TC concentration and decreased 0.8% with each 1 mg/dL increase in the serum (low-density lipoprotein) LDL-cholesterol (LDL-C) concentration. Our results indicate an association between lower serum TC concentrations and increased all-cause mortality in a community-dwelling, very elderly population. Mortality decreased with the increases in both TC and LDL-C concentrations, after adjustment for various confounding factors. These findings suggest that low TC and low LDL-C may be independent predictors of high mortality in the very elderly.
 
number of medical cases admitted into intensive care by type
Number of cases admitted into intensive care for both groups from 2007–2011.
Intensive care settings: the number of treatments on the medical intensive care unit and interdisciplinary intensive care unit of the department of anesthesiology.
The number of treatments on the general wards of the internal departments in the study group and the control group, from 2007–2011.
Gender distribution in the intensive care units.
Article
Average life expectancy has increased over the past century, leading to a larger proportion of elderly in the population. Comorbidity and dependence increases with age, and recent data have shown that the number of elderly patients admitted to intensive care is increasing. This has implications for the availability of health care for these patients, as health care is a finite resource. This study examines the demographics of patients aged over 90 years who were admitted into the medical intensive care unit, in order to verify the results of previous research. From 2007 to 2011, a retrospective study was conducted in very elderly patients (over 90 years of age) and elderly patients (between 80 and 89 years of age) admitted into intensive care in Vinzentius Hospital, a medium-size, acute-care, general hospital in Landau, Germany. A total of 8554 intensive care treatments were carried out in the study period. The number of intensive care treatments performed on patients aged over 90 years and those aged 80 to 89 years was 212 (2.48%) and 1715 (20.05%), respectively. No increase in the number of medical intensive care treatments was observed in very elderly patients over this period. Compared to the results of previous studies, an increase in the number of medical treatments in the intensive care units of patients aged over 90 years over the study period could not be found.
 
Article
The aim of this study was to examine the trend in increasing life expectancy in relation to heart attack and cardiac catheterization. A retrospective study of very elderly patients over 90 years of age (study group) and between 70 and 79 years of age (control group) with myocardial infarction and acute coronary syndrome who underwent coronary angiography was conducted. A total of 1100 cardiac catheterizations were performed in the cardiac catheterization laboratory of Vinzentius-Hospital in Landau, Germany from 2007 to 2011. The number of coronary angiographies performed in patients aged over 90 years and those aged 70-79 years was 36 and 354, respectively, during this same time period. No increase in the number of evidence-based therapy for coronary heart disease by cardiac catheterization was observed in the very elderly patients over this time period. An increase in the number of patients aged over 90 years and a rise in heart attacks, as evaluated by coronary angiography, could not be found in this study.
 
Turntable and eye movement recording setup. (A) The motorized three-dimensional turntable (Acutronic, Bubikon, Switzerland) showing author CJB. Subjects are comfortably padded with pillows and securely fastened to the chair with a five-point pilot harness, while the head is restrained with an individually molded thermoplastic mask. To give a further sense of security, subjects hold a hand bar, while the feet are restrained with a footrest. (B) Video goggles (EyeSeeCam, Munich, Germany), mounted under a thermoplastic mask to minimize head movements, are used to monitor and record eye movements.
Article
Dizziness in the elderly is a serious health concern due to the increased morbidity caused by falling. The most common cause of dizziness in the elderly, benign paroxysmal positional vertigo (BPPV), is frequently undiagnosed, and bedside treatment of these patients can be difficult due to neck and back stiffness, which makes repeated and accurate repositioning maneuvers difficult. After a fall, a 96-year-old woman was referred by a resident neurologist for intractable BPPV. The patient was placed on a motorized turntable and repositioned to remove the calcite particles from the affected posterior semicircular canal. Video monitoring of the eyes allowed confirmation of the diagnosis, as well as an immediate evaluation of the effectiveness of the maneuver. Every patient with dizziness or imbalance, even in the absence of typical complaints of BPPV, should be tested with provocation maneuvers, because the clinical picture of BPPV is not always typical. Even if elderly patients with dizziness are very frail, the completion of provocation maneuvers is imperative, since the therapeutic maneuvers are extremely effective. A motorized turntable is very helpful to perform the repositioning accurately and safely.
 
Demographic and clinical characteristics of all adults, by presence of overall and abdominal obesity 
Multivariate association of pulse wave velocity and central pulse pressure with anthropometric measurements 
Article
Limited large sample studies have specially compared overall and abdominal obesity in relation to central arterial stiffness and hemodynamics in community-dwelling adults, especially in the People's Republic of China. This study aimed to compare the relationship between an overall obesity indicator (body mass index [BMI]), an abdominal obesity index (waist circumference [WC]), and central arterial stiffness and hemodynamics, independent of age, sex, blood pressure, glucose, and lipids, in Chinese community-dwelling adults. For 2,624 adults in this study, anthropometric indices, such as BMI and WC, were measured. Central arterial stiffness was assessed by carotid-femoral pulse wave velocity (cfPWV). Central hemodynamics was represented by central pulse pressure (cPP). Both overall and abdominally obese adults were older, with significantly higher cfPWV, cPP, peripheral pulse pressure (pPP), fasting blood glucose (FBG), and low-density lipoprotein-cholesterol (LDL-C), and significantly lower high-density lipoprotein-cholesterol (HDL-C). After adjusting for age and sex, both the overall and abdominally obese individuals had independently higher pPP, FBG, and LDL-C levels, and lower HDL-C level. The overall obese individuals had independently higher cPP, but not cfPWV, after adjusting for age and sex, while the abdominally obese individuals had independently higher cfPWV, but not cPP. After adjusting for age, sex, pPP, FBG, LDL-C, and HDL-C, WC, but not BMI, was independently correlated with cfPWV, and BMI, but not WC, was independently associated with cPP. Age, sex, pPP, FBG, and HDL-C levels have independent association with cfPWV. Age, sex, pPP, but not FBG and HDL-C levels, have independent association with cPP. The abdominal obesity index (WC), rather than the overall obesity indicator (BMI), was related to central arterial stiffness, independent of age, sex, blood pressure, glucose and lipids, while the overall obesity indicator (BMI), rather than the abdominal obesity indicator (WC), was independently correlated with central hemodynamics. Age, sex, and blood pressure were independently associated with central arterial stiffness and hemodynamics, but blood glucose and lipids were independently associated with central arterial stiffness, rather than hemodynamics.
 
Article
Background Despite advances in operative repair, ruptured abdominal aortic aneurysm (rAAA) remains associated with high mortality and morbidity rates, especially in elderly patients. The purpose of this study was to evaluate the outcomes of emergency endovascular aneurysm repair (eEVAR), conventional open repair (OPEN), and conservative treatment in elderly patients with rAAA. Methods We conducted a retrospective study of all rAAA patients treated with OPEN or eEVAR between January 2005 and December 2011 in the vascular surgery department at Amphia Hospital, the Netherlands. The outcome in patients treated for rAAA by eEVAR or OPEN repair was investigated. Special attention was paid to patients who were admitted and did not receive operative intervention due to serious comorbidity, extremely advanced age, or poor physical condition. We calculated the 30-day rAAA-related mortality for all rAAA patients admitted to our hospital. Results Twelve patients did not receive operative emergency repair due to extreme fragility (mean age 87 years, median time to mortality 27 hours). Twenty-three patients had eEVAR and 82 had OPEN surgery. The 30-day mortality rate in operated patients was 30% (7/23) in the eEVAR group versus 26% (21/82) in the OPEN group (P=0.64). No difference in mortality was noted between eEVAR and OPEN over 5 years of follow-up. There were more cardiac adverse events in the OPEN group (n=25, 31%) than in the eEVAR group (n=2, 9%; P=0.035). Reintervention after discharge was more frequent in patients who received eEVAR (35%) than in patients who had OPEN (6%, P<0.001). Advancing age was associated with increasing mortality (hazard ratio 1.05 [95% confidence interval 1.01–1.09]) per year for patients who received operative repair, with a 67%, 76%, and 100% 5-year mortality rate in the 34 patients aged <70 years, 59 patients aged 70–79 years, and 12 octogenarians, respectively; 30-day rAAA-related mortality was also associated with increasing age (21%, 30%, and 61%, respectively; P=0.008). Conclusion The 30-day and 5-year mortality in patients who survived rAAA was equal between the treatment options of eEVAR and OPEN. Particularly fragile and very elderly patients did not receive operative repair. The decision to intervene in rAAA should not be made on the basis of patient age alone, but also in relation to comorbidity and patient preference.
 
Baseline characteristics of the WB-eMs and control groups
Whole-body electromyostimulation electrodes (vest and sleeves). 
Baseline and follow-up data, absolute changes, and statistical parameters of primary endpoints in the WB-eMs and control groups
Whole-body electromyostimulation exercise protocol. 
Article
The primary aim of this study was to determine the effect of 12 months of whole-body electromyostimulation (WB-EMS) exercise on appendicular muscle mass and abdominal fat mass in subjects specifically at risk for sarcopenia and abdominal obesity, but unable or unwilling to exercise conventionally. Forty-six lean, nonsportive (<60 minutes of exercise per week), elderly women (aged 75 ± 4 years) with abdominal obesity according to International Diabetes Federation criteria were randomly assigned to either a WB-EMS group (n=23) which performed 18 minutes of intermittent, bipolar WB-EMS (85 Hz) three sessions in 14 days or an "active" control group (n=23). Whole-body and regional body composition was assessed by dual energy X-ray absorptiometry to determine appendicular muscle mass, upper leg muscle mass, abdominal fat mass, and upper leg fat mass. Maximum strength of the leg extensors was determined isometrically by force plates. After 12 months, significant intergroup differences were detected for the primary end-points of appendicular muscle mass (0.5% ± 2.0% for the WB-EMS group versus -0.8% ± 2.0% for the control group, P=0.025) and abdominal fat mass (-1.2% ± 5.9% for the WB-EMS group versus 2.4% ± 5.8% for the control group, P=0.038). Further, upper leg lean muscle mass changed favorably in the WB-EMS group (0.5% ± 2.5% versus -0.9% ± 1.9%, in the control group, P=0.033), while effects for upper leg fat mass were borderline nonsignificant (-0.8% ± 3.5% for the WB-EMS group versus 1.0% ± 2.6% for the control group, P=0.050). With respect to functional parameters, the effects for leg extensor strength were again significant, with more favorable changes in the WB-EMS group (9.1% ± 11.2% versus 1.0% ± 8.1% in the control group, P=0.010). In summary, WB-EMS showed positive effects on the parameters of sarcopenia and regional fat accumulation. Further, considering the good acceptance of this technology by this nonsportive elderly cohort at risk for sarcopenia and abdominal obesity, WB-EMS may be a less off-putting alternative to impact appendicular muscle mass and abdominal fat mass, at least for subjects unwilling or unable to exercise conventionally.
 
Article
Abdominal cavity drainage fluid can be used as an early diagnostic tool of postoperative complications, and observing its characteristics can help us to judge and handle postoperative complications. There is no accurate standard reference range on its characteristics after surgeries for gastrointestinal or retroperitoneal tumors. This research attempted to analyze its characteristics in Chinese patients without postoperative complications after surgery for gastrointestinal or retroperitoneal tumors, and to offer an experimental basis for establishing a reliable standard reference range for abdominal cavity drainage fluid used to detect postoperative complications. This study enrolled 262 Chinese patients without postoperative complications after surgery for gastrointestinal or retroperitoneal tumors. All patients had a median age (range) of 55 (19-72) years, and 150 (57.3%) were men. There were 93 (35.5%), 115 (43.9%), and 54 (20.6%) patients who underwent surgery for upper gastrointestinal tumors, lower gastrointestinal tumors, and retroperitoneal tumors, respectively. The total amount, density, and pH of the abdominal cavity drainage fluid were 204 (0-6,195) mL, 1.032 (1.011-1.047) kg/m(3), and pH 7.0 (5.0-7.5), respectively. The total numbers of cells and white blood cells were 1.3×10(11) (5.5×10(8)-6.2×10(12))/L and 3.7×10(9) (1.0×10(7)-5.0×10(11))/L, respectively. The levels of sugar and protein were 3 (0-37) mmol/L and 39 (1-272) g/L. The total amount of abdominal cavity drainage fluid, the total number of cells, the total number of white blood cells, the number of multinucleated cells, the number of monocytes, and the levels of sugar were statistically significantly different between the three groups (P<0.05 for all). This study described the characteristics of abdominal cavity drainage fluid in Chinese patients without postoperative complications after surgery for gastrointestinal or retroperitoneal tumors, and provided an experimental basis for establishing a reliable standard reference range for abdominal cavity drainage fluid for screening for postoperative complications.
 
Results on cognitive tests, mean and SD at baseline for the study population and dropouts 
Pearson's correlation coefficients between the six cognitive domains at baseline and LSI-A at reexamination 
Article
Studies on the associations between cognitive abilities and life satisfaction (LS) in the oldest-old are few. The aim of this study was to explore whether abilities in six different cognitive domains could predict LS in the oldest-old 3 years later. The study population consisted of 681 individuals aged 78-98 years, drawn from the longitudinal population study "Good Aging in Skåne," which is part of a national survey (The Swedish National Study on Aging and Care). Scores on 13 cognitive tests were related to scores on Neugartens' LS index A (LSI-A) 3 years later. The cognitive tests were added into six different cognitive domains. A multiple regression analysis was constructed for each cognitive domain separately, with scores on the LSI-A as the dependent variable. The model was adjusted stepwise for sex, age, education, functional capacity, and depressive mood. Significant correlations were found between digit cancellation, word recall, verbal fluency (VF) A, VF animals, VF occupations, and mental rotations at baseline, as well as LSI-A at follow-up. The domains of spatial abilities (B = 0.453, P = 0.014) and processing speed (B = 0.118, P = 0.020) remained significantly associated with LSI-A 3 years later after adjustment. The cognitive domains of spatial abilities and processing speed predicted LS 3 years later in the oldest-old. Clinical implications are discussed.
 
Article
To evaluate for the first time the efficacy of safe-sourced phosphatidylserine-containing omega-3 long chain polyunsaturated fatty acid (PS-omega-3) in improving memory abilities. PS-omega-3 was administered daily for 6 weeks to eight elderly volunteers with subjective memory complaints. The Cognitive Drug Research test battery was used to assess the effect on their cognitive abilities. PS-omega-3 supplementation resulted in 42% increase in the ability to recall words in the delayed condition. PS-omega-3 may have a favorable effect on memory in subjects with subjective memory complaints. PS-omega-3 may serve as a safe alternative to phosphatidylserine extracted from bovine cortex.
 
Basic characteristics of all subjects stratified by sex 
Area under the curve and cut-off values of anthropometric indices for identifying cardiometabolic abnormalities 
Article
The study aimed to investigate the prevalence of overweight, obesity, and cardiometabolic abnormalities, the influence of residence area, occupation, and lifestyle on new anthropometric indices, and the relationship between anthropometric indices and cardiometabolic abnormalities in a Chinese community-dwelling population. The study included 4,868 residents through a large health check-up program in Beijing. Overall obesity existed in 22.2% of men and 28.1% of women. 67.1% of men and 65.2% of women were overweight. 65.99% of men and 65.97% of women had central obesity. Residents of rural areas, manual workers, and smokers had significantly higher anthropometric indices. The power of each anthropometric index varied for identifying different cardiometabolic abnormalities, and the ability of the waist-to-height ratio to identify participants with greater than one or two cardiometabolic abnormalities was optimal. The appropriate cut-off values of all anthropometric indices for cardiometabolic abnormalities were obtained. Overweight is common for both sexes in the People's Republic of China, as are general and central obesity. Residents of rural areas, manual workers, and smokers have significantly higher anthropometric indices. Waist-to-height ratio has the ability to reflect the compound risk of different cardiometabolic abnormalities and the greatest potential to be widely applied in clinical practice.
 
GFR determined by each equation and prevalence of a GFR , 60 mL/minute/1.73 m 2 . (A) The GFR determined by each equation decreased as the 10-year age categories increased. (B) The prevalence of a GFR , 60 mL/minute/1.73 m 2 was proportional to the 10-year age categories. Abbreviations: GFR, glomerular filtration rate; MDRD, Modification of Diet in Renal Disease Study equation; CMDRD, Chinese MDRD equation; CKD-EPI, Chronic Kidney Disease Epidemiology Collaboration equation; Mayo, Mayo Clinic quadratic equation.  
numbers of patients and mortality rates at each GFR category 
The reclassification of patients at different GFR categories 
The net reclassification improvement in risk of mortality 
Article
As a standard indicator of renal function, the glomerular filtration rate (GFR) is vital for the prognostic analysis of elderly patients with coronary artery disease (CAD). Thus, the search for the calculation equation of GFR with the best prognostic ability is an important task. The most commonly used Modification of Diet in Renal Disease (MDRD) equation and the Chinese version (CMDRD) of the MDRD equation has many shortcomings. The newly developed Mayo Clinic quadratic (Mayo) and Chronic Kidney Disease (CKD) Epidemiology Collaboration (CKD-EPI) equations may overcome these shortcomings. Because the populations involved in these equation-related studies are almost completely devoid of subjects > 70 years of age, there are more debates on the performance of these equations in the elderly. This study was designed to compare the prognostic abilities of different calculation formulas for the GFR in elderly Chinese patients with CAD. This study included 1050 patients (≥60 years of age) with CAD. The endpoint was all-cause mortality over a mean follow-up period of 417 days. The median age was 86 years (60-104 years). The median values for the MDRD-GFR, CMDRD-GFR, CKD-EPI-GFR, and Mayo-GFR were 66.0, 69.2, 65.6, and 75.8 mL/minute/1.73 m, respectively. The prevalence of GFR < 60 mL/minute/1.73 m based on these measures was 39.3%, 35.4%, 43.0%, and 28.7%, respectively. Their area under the curve values for predicting death were 0.611, 0.610, 0.625, and 0.632, respectively. Their cut-off points for predicting death were 54.1, 53.5, 48.0, and 57.4 mL/minute/1.73 m, respectively. Compared with the MDRD-GFR, the net reclassification improvement values of the CMDRD-GFR, CKD-EPI-GFR, and Mayo-GFR were 0.02, 0.10, and 0.14, respectively. The prognostic abilities of the CKD-EPI and Mayo equations were significantly superior to the MDRD and CMDRD equations; the Mayo equation had a mild, but not statistically significant superiority compared with the CKD-EPI equation in elderly Chinese patients with CAD.
 
Article
During menopause vasomotor symptoms are one of the main complaints about which women seek medical advice. For symptom control, several therapies have been used, among which hormone therapy has produced good results. One of these is estrogen monotherapy, which unfortunately may induce endometrial hyperplasia in women with an intact uterus. A progestin must be added to avoid this risk. Progestins may induce several secondary effects such as breast tenderness, hirsutism, edema and unfavorable lipid profile modifications. Recently a new progestin called drospirenone has been synthesized and used in combination with estradiol for the treatment of postmenopausal women. This progestin is derived from spironolactone, and lacks estrogenic, androgenic and glucocorticoid activities. Several studies have evaluated safety, efficacy and patient tolerability, and have shown a good profile in all these parameters. All studies agree that the combination of estradiol 1 mg plus drospirenone 2 mg is a good choice for postmenopausal women with vasomotor symptoms.
 
Patient characteristics, coronary angiography results, and lesion characteristics at baseline 
Article
Objective To evaluate the safety and efficacy of transradial approach for emergent percutaneous coronary intervention in patients with acute myocardial infarction. Methods We analysed data from our single-center registry on 560 consecutive patients between January 2001 and October 2009. All the patients were respectively randomised to transradial group (n=260) and trans-femoral group (n=300). A dedicated doctor was appointed to collect such indicators as follows: puncture time, CAG time, PCI time, x-ray exposure time, complication rates associated with puncture such as puncture site bleeding, haematoma, pseudoaneurysm, and the major adverse cardiac events. Results 1. There were no significant differences in the baseline characteristics and angiographic findings between two groups. 2. There was no significant differences in CAG time (8±2.4min vs 7.6±2.0min), PCI time (30±4.8min vs 28.6±4.4 min), and x-ray exposure time (4.6±1.4 min vs 4.4±1.3 min) between two groups. 3. The complication rates of TRA was 2.32%(6/260), compared to 6.0% (18/300) in the control group (p<0.05). Conclusion Transradial approach for emergent percutaneous coronary intervention in patients with acute myocardial infarction is safe and efficacy, and it is suggested that the transradial approach should be used in patients with acute myocardial infarction.
 
Association between HARP and quality of life components (MCS and PCS)
Quality of life (as measured by SF12 component scores) and predictor variables of FD
Age-sex classifications for participants.
Receiver operator characteristic curve derived from HARP predicting consistently low or declining PCS over 2 months (1 and 3 months after HARP was calculated).
Abbreviations: HARP, Hospital Admission Risk Profile; PCS, physical component score.
Three month trajectory of the likelihood of high PCS (from SF12 quality of life measure; ORs, 95% CIs), after being assessed with a moderate or high HARP score at baseline.
Abbreviations: CI, confidence interval; HARP, Hospital Admission Risk Profile; L, lower; OR, odds ratio; PCS, physical component score; U, upper; SF12, 12-item Short Form Health Survey.
Article
The Hospital Admission Risk Profile (HARP) instrument is commonly used to assess risk of functional decline when older people are admitted to hospital. HARP has moderate diagnostic accuracy (65%) for downstream decreased scores in activities of daily living. This paper reports the diagnostic accuracy of HARP for downstream quality of life. It also tests whether adding other measures to HARP improves its diagnostic accuracy. One hundred and forty-eight independent community dwelling individuals aged 65 years or older were recruited in the emergency department of one large Australian hospital with a medical problem for which they were discharged without a hospital ward admission. Data, including age, sex, primary language, highest level of education, postcode, living status, requiring care for daily activities, using a gait aid, receiving formal community supports, instrumental activities of daily living in the last week, hospitalization and falls in the last 12 months, and mental state were collected at recruitment. HARP scores were derived from a formula that summed scores assigned to age, activities of daily living, and mental state categories. Physical and mental component scores of a quality of life measure were captured by telephone interview at 1 and 3 months after recruitment. HARP scores are moderately accurate at predicting downstream decline in physical quality of life, but did not predict downstream decline in mental quality of life. The addition of other variables to HARP did not improve its diagnostic accuracy for either measure of quality of life. HARP is a poor predictor of quality of life.
 
Characteristics of study population, older persons aged 65 and over 
Predictors of discharge to home from the ACE Unit a 
Article
Older adults age 65 and over account for a disproportional number of hospital stays and discharges compared to other age groups. The objective of this paper is to describe placement and characteristics of older patients discharged from an acute care for the elderly (ACE) unit. The study sample consists of 1,351 men and women aged 65 years or older that were discharged from the ACE Unit during a 12-month period. The mean number of discharges per month was 109.2 +/- 28.4. Most of the subjects were discharged home or home with home health 841, 62.3%. The oldest elderly and patients who had been admitted from long-term care institutions or from skilled nursing facilities to the ACE unit were less likely to return to home.
 
Schematic diagram of the anecortave acetate, a unique synthetic cortisene. Modifications made to the cortisol parent molecule are shown.  
CNV therapies currently approved or under clinical development
The counter pressure device prevents reflux of anecortave acetate when placed as posterior as possible in position with the posterior juxtascleral depot cannula.  
Anecortave acetate blocks proteolytic cascade in the vascular endothelial cells (VEC).  
Evidence supports use of counter pressure device (CPD) for managing reflux. Plasma concentrations of anecortave desacetate in patients with the CPD (C- 04-50) were the same as the plasma concentrations in patients without the CPD and had no reflux (C-02-47). Patients (C-02-47) with reflux had 4 fold lower levels of anecortave desacetate than patients without reflux. In the C-04-50 study, the CPD prevented reflux in 100% of the patients.  
Article
RETAANE 15mg (anecortave acetate suspension) is under investigation to treat exudative age-related macular degeneration (AMD), the single largest cause of blindness in the Western world, affecting over 15 million people in the USA. RETAANE suspension is a unique synthetic cortisene and has antiangiogenic properties that were established in multiple experimental models of angiogenesis. The molecule acts at multiple sites of the angiogenic cascade. Clinical trials in patients with exudative AMD have demonstrated the excellent safety record of both the drug anecortave acetate and the posterior juxtascleral depot (PJD) administration procedure. A pivotal study comparing RETAANE suspension with placebo showed a significantly higher chance of maintaining vision in the treatment (73%) as compared with placebo (47%). Another study compared RETAANE suspension with Visudyne photodynamic therapy, revealing no statistically significant differences between the two treatments over 24 months. AMD is a multi-faceted disease and therefore a molecule such as RETAANE suspension with a unique mechanism of action, demonstrated clinical efficacy, and retreatment every six months is an important potential treatment option which should be further investigated both as a monotherapy or in combination with other treatment strategies.
 
Summary of included publications 
Summary of pivotal study results 
Article
For nearly three decades, gonadotropin-releasing hormone (GnRH) agonists, particularly leuprorelin acetate (LA), have served as an important part of the treatment armamentarium for prostate cancer. The introduction of LA depot formulations provided a significant improvement in the acceptance of this therapy; however, their indicated treatment duration of 1 to 4 months was still not long enough to satisfy all medical needs. For this reason some manufacturers developed new injectable formulations that provide testosterone suppression for 6 months. This review article assesses key publications in order to compare these long-acting, commercially available, LA depot formulations and their clinical performance. The literature search identified 14 publications; by excluding reviews, duplications, and non-English articles, only three original papers describing clinical trial remained for review: two focused on microsphere-based LA formulations with either a 30 mg or 45 mg dose and one focused on a gel-based leuprorelin acetate with a 45 mg dose. All products were tested in individual clinical trials and have demonstrated their efficacy and safety.
 
Top-cited authors
David Della-Morte
  • University of Miami Miller School of Medicine
Pasquale Abete
  • University of Naples Federico II
Francesco Cacciatore
  • AORN Ospedali dei Colli
Gennaro Russo
  • University of Naples Federico II
Gianluca Testa
  • Università degli Studi del Molise