Search

Key summary points Aim To assess the impact on the older population of policies to decrease the overall impact of the COVID-19 pandemic in Europe. Findings Ageism has occurred during the COVID-19 pandemic. Message Analysis of the effects of the COVID-19 pandemic on the older population will help us to develop fairer and more inclusive policies in the future., Purpose The United Nations (UN) has published a Policy Brief on the impact of the Coronavirus Disease 2019 (COVID-19) that identifies policies and responses to protect older adults. Our objective was to summarize actions, health policies and clinical guidelines adopted by six European countries (Belgium, France, Italy, Poland, Spain and United Kingdom) during the pandemic, and to assess the impact of national policies on reducing adverse effects of the COVID-19 pandemic in older populations. Methods Reports by geriatricians on the measures and actions undertaken by governmental institutions in each country between March and July 2020, as well as the role of primary care during the pandemic, covered three areas: (a) general health strategies related to the pandemic; (b) impact of COVID-19 on health inequity; and (c) initiatives and challenges for the COVID-19 pandemic and beyond. Results In the six countries, COVID-19 mortality in nursing homes ranged from 26 to 66%. Although all countries endorsed the World Health Organization general recommendations, the reports identified the lack of harmonized European guidelines and policies for nursing homes, with competencies transferred to national (or regional) governments. All countries restricted visits in nursing homes, but no specific action plans were provided. The role of primary care was limited by the centralization of the crisis in hospital settings. Conclusions The older population has been greatly affected by COVID-19 and by the policies initiated to control its spread. The right to health and dignity are transgenerational; chronological age should not be the sole criterion in policy decisions.

Purpose: The parameters of cerebral blood flow are modulated by many factors. The aim of the study was to prospectively assess the relationship between the number of the established cardiovascular ...

To assess the relationship between ankle-brachial index (ABI) and up to 10-year mortality in older individuals below and above the age of 80 years. In a multicenter survey of health status in the community dwelling subjects aged 55–59 and 65 + years in Poland, we assessed baseline medical history including risk-factors. We measured ABI, and serum creatinine, cholesterol, NT-proBNP, and interleukin-6 (IL-6) concentrations. We assessed mortality based on public registry. Between 2009 and 2019, 27.3% of 561 participants p 0.001); 67.8, 41.5, and 40.3% in the ABI groups 1.4, respectively (p 0.01). In the unadjusted Cox models, ABI was associated with mortality in the entire group, and p 0.001). In stepwise regression ABI

We decided to perform computer-aided analysis of the anterior cerebral artery (ACA) to check for a potential correlation with anterior communicating artery (ACoA) aneurysm presence and growth. We retrospectively analyzed the ACA anatomy of 121 patients with ACoA aneurysms along with 121 age, risk factors, and vessel side-matched control patients without an ACoA aneurysm. We obtained their medical history and digital subtraction angiography (DSA) data from their medical records. For each patient’s DSA, we extracted curve representing the course of their ACA and calculated its relative length (RL), sum of angle metrics (SOAM), triangular index (TI), product of angle distance (PAD), and inflection count metrics (ICM). Patients with ACoA aneurysm had significantly higher RL (0.64 ± 0.23 vs. 0.56 ± 0.22; p

Prevalence of peripheral arterial disease increases with age and is related to increased morbidity and mortality. The clinical diagnosis includes the measurement of ankle-brachial index (ABI).To check the prevalence of abnormal ABI, and the value of physical examination of arterial system in detection of ABI 0.9.We performed subgroup analysis of patients included in the PolSenior survey. We measured ABI, performed physical examination of arterial system, assessed laboratory and questionnaire factors related to atherosclerosis. Participants were divided according to ABI strata of 0.9, 0.9-1.4 and 1.4. Clinical score of abnormalities on physical examination was proposed. Using logistic regression, we obtained areas under the curve (AUC).The mean age of 844 participants (53.3% men) was 74.7 (10.6) years. ABI 0.9 was found in 20.3% participants and it was linked to history of myocardial infarction, hypertension and renal failure. In the entire group, 72.4% of subjects declared, that they were able to walk a distance of 200 m without interruption. Higher clinical score was associated with lower ABI. Full physical examination (AUC = 0.67) followed by examination of lower extremities (AUC = 0.65) showed strongest diagnostic value for PAD based on ABI. Neither ABI nor clinical examination was a good predictor of the inability to walk 200 meters without difficulties.Full clinical examination, only moderately, adds to detection of PAD. The ability to walk 200 m is not a good measure of PAD in older subjects.

ObjectiveVitamin D plays an important role in mineral turnover and bone remodeling and there are increasing data about its immunomodulatory potential in different rheumatologic disorders. Deficiency of vitamin D is frequent in patients with spondyloarthritis (SpA) and some data suggest its association with increased disease activity and structural damage. However, its exact role in the pathogenesis of SpA and its association with disease activity are still a matter of debate.Material and methodsA cross-sectional study of patients diagnosed with axial spondyloarthritis (axSpA) and peripheral spondyloarthritis (perSpA) according to Assessment of Spondyloarthritis International Society classification criteria was performed. The correlation between concentration of 25-hydroxyvitamin D – 25(OH)D – and disease activity scores (Bath Ankylosing Spondylitis Disease Activity Index – BASDAI, Ankylosing Spondylitis Disease Activity Score – ASDAS), inflammatory markers (C-reactive protein – CRP, erythrocyte sedimentation rate – ESR) and clinical symptoms (arthritis, enthesitis, dactylitis) was performed.ResultsWe included 40 patients with axSpA and 23 patients with perSpA. The mean concentration of 25(OH)D was 24.9 ng/ml (SD 12.49). Forty-seven (74.6%) patients had 25(OH)D below the recommended threshold (< 30 ng/ml). We found no statistically significant negative correlation between the level of 25(OH)D and disease activity of axSpA and perSpA in terms of clinical symptoms (arthritis, enthesitis, dactylitis), inflammatory markers (ESR, CRP) and disease activity scores (BASDAI, ASDAS). These results did not change after adjustment for supplementation of vitamin D and seasonal variation.ConclusionsOur data show no correlation between the concentration of 25(OH)D in the serum and disease activity in two subgroups of SpA. However, this does not exclude the potential role of vitamin D in pathogenesis of SpA. Further studies are required to evaluate the optimal range of 25(OH)D serum concentration in axSpA and perSpA patients with its possible immunomodulatory potential and influence on disease activity.

The aim of this study is to investigate the relationships between insomnia and metabolic syndrome among Taiwanese older adults.This cross-sectional study enrolled participants aged over 60 years from outpatient clinics between July and September 2018. Demographic characteristics of all participants and questionnaire data for sleep duration, use of hypnotic agents, baseline activities of daily living, 5 items of the geriatric depression scale, comorbidities, medications, and risk of obstructive sleep apnea were obtained. Insomnia was defined by scores of questionnaires of the Chinese version of the Athens Insomnia Scale higher or equal to 6 points. Metabolic syndrome was diagnosed according to criteria of the National Cholesterol Education Program Adult Treatment Panel III. Multivariable forward stepwise logistic regression analysis was applied to investigate independent associations between insomnia and metabolic syndrome before and after stratifying by gender.Among the 336 participants (mean age 74.9 ± 8.5 years, female 49.1%), 63.1% participants had metabolic syndrome, with significantly higher prevalence among females than males (males 56.7%; females 69.7%). Participants with metabolic syndrome had higher rates of insomnia (34.0% vs. 21.8%, P = 0.018). The significant associations between insomnia and metabolic syndrome disappeared after adjusting for all covariates. However, insomnia was independently associated with metabolic syndrome in older females (adjusted OR 2.614, 95% CI 1.011-6.763, P = 0.048) after adjusting for all covariates.Insomnia is significantly associated with metabolic syndrome among older female adults. These findings suggest that gender may play a role in the pathogenesis of insomnia and metabolic syndrome in older adults.

Background Sarcopenia is a potentially reversible condition, which requires proper screening and diagnosis. Aims To validate a Polish version of sarcopenia screening questionnaire (SARC-F), and assess its clinical performance. Methods Cross-sectional validation study in community-dwelling subjects ≥ 65 years of age. Diagnosis of sarcopenia was based on the 2018 2nd European Working Group on Sarcopenia in Older People (EWGSOP2) consensus. Hand grip and 4-m gait speed were measured, and the Polish version of SARC-F was administered. Results The mean (SD) age of 73 participants (21.9% men) was 77.8 (7.3) years. Seventeen participants (23.3%) fulfilled the EWGSOP2 criteria of sarcopenia, and 9 (12.3%) criteria for severe sarcopenia. Fourteen (19.2%) participants fulfilled the SARC-F criteria for clinical suspicion of sarcopenia. The Cronbach’s alpha coefficient for internal was 0.84. With EWGSOP2 sarcopenia as a gold standard, the sensitivity of SARC-F was 35.3% (95% CI 14.2–61.7, p = 0.33), specificity was 85.7% (95% CI 73.8–93.6, p p = 0.79) and 81.4% (p p p = 0.33). Overall the predictive power of SARC-F was low (c-statistic 0.64). Discussion SARC-F is currently recommended for sarcopenia case finding in general population of older adults. However, its sensitivity is low, despite high specificity. Conclusions At present SARC-F is better suited to rule out sarcopenia then to case-finding. Further refinement of screening for sarcopenia with the use of SARC-F seems needed.

Multimorbidity has been recognized as an important factor in geriatric medicine. However, its importance for other specialists is still to be fully appreciated.The aim of the study was to assess the prevalence and patterns of multimorbidity in older patients drawn from the general population.The PolSenior was a nationwide, multicenter, cross-sectional survey of aged population in Poland. Questionnaire, physical examination, and laboratory data were gathered. Multimorbidity was defined as a coexistence of 2 and more chronic diseases or medical problems out of 17 identified. Factor analysis was employed to identify clusters of conditions.Of 4588 patients, 51.9% were men; 640 were aged 55 to 59 years; 3948, ≥65 years; and 1757, ≥80 years. Multimorbidity depended on age and sex, and was diagnosed in 70.9% of those aged 55 to 59 years, 88.4% of those aged 65 to 79 years, and 93.9% of those aged ≥80 years. Only 8.5% of participants aged 55 to 59, 2.2% aged 65 to 79 years, and 0.9% aged ≥80 years had no diagnosis of chronic disease. Hypertension, metabolic diseases, and obesity predominated in those aged 55 to 59 and 65 to 79 years, whereas hypertension, eye disorders, and cognitive impairment prevailed in the oldest group. The highest likelihood of multimorbidity was found in the youngest participants who had stroke, kidney disease, cancer, or a composite of Parkinson disease / epilepsy; in 65-to-79-year-olds with a history of stroke; and in ≥80-year-olds with a history of stroke or heart failure.The age-specific analysis of clustering revealed differences in prevalence and patterns of comorbidities, which stresses the importance of individual approach to older patients.

In this review, we discuss the pathophysiologic and management aspects of acute sarcopenia in relation to SARS-CoV-2 infection. COVID-19 is as a multi-organ infectious disease characterized by a severe inflammatory and highly catabolic status, influencing the deep changes in the body build, especially the amount, structure, and function of skeletal muscles which would amount to acutely developed sarcopenia. Acute sarcopenia may largely impact patients’ in-hospital prognosis as well as the vulnerability to the post-COVID-19 functional and physical deterioration. The individual outcome of the COVID-19 and the degree of muscle mass and functional loss may be influenced by multiple factors, including the patient’s general pre-infection medical and functional condition, especially in older adults. This paper gathers the information about how the SARS-CoV-2 hyper-inflammatory involvement exacerbates the immunosenescence process, enhances the endothelial damage, and due to mitochondrial dysfunction and autophagy, induces myofibrillar breakdown and muscle degradation. The aftermath of these acute and complex immunological SARS-CoV-2-related phenomena, augmented by anosmia, ageusia and altered microbiota may lead to decreased food intake and exacerbated catabolism. Moreover, the imposed physical inactivity, lock-down, quarantine or acute hospitalization with bedrest would intensify the acute sarcopenia process. All these deleterious mechanisms must be swiftly put to a check by a multidisciplinary approach including nutritional support, early physical as well cardio-pulmonary rehabilitation, and psychological support and cognitive training. The proposed holistic and early management of COVID-19 patients appears essential to minimize the disastrous functional outcomes of this disease and allow avoiding the long COVID-19 syndrome.

OBJECTIVE To assess changes of post-occlusive reactive hyperemic response in skin microcirculation among extremely obese patients 10 days and 6 months after bariatric surgery for patients with and without hypertension. METHODS Skin blood flow was measured using PeriFlux laser Doppler fluxmetry. Data were analyzed in the entire group and two subgroups: with and without hypertension. RESULTS Data from 88 patients (mean age 42.1 ± 11.2 years, 40.5% men) were analyzed. Six months after bariatric surgery, the time to reach peak flows had been shortened (2.4 ± 1.7 vs 2.1 ± 1.0 seconds, P

The association between intracerebral hemorrhage (ICH) shape and a poor treatment outcome has been established by few authors. We decided to analyze whether computationally assessed hemorrhage shape irregularity is associated with any known predictors of its poor treatment outcome. We retrospectively analyzed 48 patients with spontaneous intracerebral hemorrhage. For each patient we calculated Fractal Dimension, Compactness, Fourier Factor and Circle Factor. Our study showed that patients above 65 years old had significantly higher Compactness (0.70 &plusmn, 0.19 vs. 0.56 &plusmn, 0.20, p &lt, 0.01), Fractal Dimension (0.46 &plusmn, 0.22 vs. 0.32 &plusmn, p = 0.03) and Circle Factor (0.51 &plusmn, 0.25 vs. 0.35 &plusmn, 0.17, 0.01). Patients with hemorrhage growth had significantly higher Compactness (0.74 &plusmn, 0.23 vs. 0.58 &plusmn, 0.18, 0.01), Circle Factor (0.55 &plusmn, 0.27 vs. 0.37 &plusmn, 0.01) and Fourier Factor (0.96 &plusmn, 0.06 vs. 0.84 &plusmn, 0.19, p = 0.03). In conclusion, irregularity resulting from the number of appendices can be a predictor of ICH growth, however, the size of those appendices is also important. Shape roughness better reflects the severity of brain tissue damage and a patient&rsquo, s general condition.

Objectives We analysed tortuosity of basilar artery (BA) to determine its relationship with the presence of aneurysm. Methods We retrospectively analysed 71 patients with BA aneurysms along with 71 age- and risk factors-matched control patients without BA aneurysm. From patients’ medical records, we obtained their history including previous and current diseases and medications. For each patient, we calculated relative length (RL), sum of angle metrics (SOAM), triangular index (TI), product of angle distance (PAD) and inflexion count metrics (ICM). We used t-test and Mann-Whitney U test for continuous variables and χ2 test for dichotomised variables. To find independent predictors of BA aneurysm, we employed logistic regression analysis. Results We found significant positive correlation between age and SOAM (R = 0.195, p = 0.02) and PAD (R = 0.199, p = 0.018). Our study also showed that patients with BA aneurysm had significantly higher SOAM (0.21 ± 0.16 vs. 0.11 ± 0.08; p p p p = 0.045). In multivariate logistic regression analysis, after adjustment for all possible confounders, SOAM (OR = 1.086; 95% CI 1.046–1.136; p p Conclusions Increased tortuosity of BA is associated with higher risk of its aneurysm development. Key Points • Basilar artery sum of angle metrics and product of angle distance are correlated with age. • Basilar artery tortuosity is independently associated with higher risk of its aneurysm development. • Basilar artery tortuosity is positively correlated with its diameter and bifurcation angle.

Cardiovascular disease burden increases with the increasing age of populations. Also, with increasing longevity, some individuals are ageing along an unfavourable path developing frailty syndrome. Epidemiologic studies indicate that frailty is overrepresented among the persons with cardiovascular disease. On the other hand, frail subjects tend to be burdened with cardiovascular disease to a greater degree than their biologically better-off peers. Hypertension, diabetes, and obesity, especially abdominal, and at least some other risk factors appear to be shared between frailty and cardiovascular disease. The probable common underlying pathophysiologic feature is inflammation and associated phenomena, possibly having its root in the inflammageing. We discuss these issues based on the results of original studies, comprehensive literature reviews, and metaanalyses, by hundreds of dedicated researchers worldwide.

Objectives: Report on one-year results from the Polish Spondyloarthritis Initiative registry (PolSPI), containing the cross-sectional analysis of clinical and imaging data as well as database methodology. Material and methods: The PolSPI registry includes patients with axial (axSpA) and peripheral (perSpA) spondyloarthritis according to ASAS classification criteria, and/or patients with ankylosing spondylitis according to modified New York criteria, psoriatic arthritis according to CASPAR criteria, arthropathy in inflammatory bowel disease, reactive arthritis, juvenile spondyloarthritis or undifferentiated spondyloarthritis. Epidemiologic data and history of signs, symptoms and treatment of spondyloarthritis are collected and assessment of disease activity is performed. Radiographic images of sacroiliac joint, cervical and lumbar spine, and results of bone densitometry are collected. Every 6 months blood samples for inflammatory markers, and for long-term storage are taken. Results: During a one-year period from September 2015 to August 2016, 63 patients were registered on an electronic database; 44 (69.8%) of patients were classified as axial spondyloarthritis (axSpA) and 19 (30.2%) as peripheral spondyloarthritis (perSpA) according to ASAS criteria. Statistically significant differences between axSpA and perSpA were discovered in the percentage of HLA-B27 antigen occurrence (92.6% and 50%, respectively), BASDAI (2.8% and 4.1%, respectively), DAS 28 (2.66% and 4.03%, respectively), percentage of peripheral arthritis (20% and 88.8%, respectively), enthesitis (26.7% and 70.6%, respectively), dactylitis (6.7% and 88.9%, respectively), as well as extra-articular symptoms: acute anterior uveitis (26.7% and 5.6% , respectively) and psoriasis (6.9% and 55.6%, respectively). Patients with axSpA had significantly higher mean grade of sacroiliac involvement according to New York criteria, higher mSASSS score, and lower T-score in femoral neck in bone densitometry. Conclusions: At the early stage of the disease patients with axSpA compared to those with perSpA, have more advanced structural damage of sacroiliac joints and spine, and lower bone mineral density in the femoral neck. In the upcoming years the PolSPI registry will prospectively follow-up patients with SpA, recording response to treatment and carrying out research on interaction of inflammation and bone remodelling.

BACKGROUND Insulin resistance and renal tubular sodium handling influence arterial structure and function and play an essential role in salt-sensitive forms of hypertension. METHODS In a population with prevailing sodium consumption, we assessed the relationship between cardiovascular phenotypes (peripheral and central blood pressures, elastic properties of large arteries, the left ventricular structure) and sodium handling parameters (daily urinary sodium excretion, fractional urinary lithium excretion in proximal—FELi and distal tubules), as a function of insulin sensitivity—measured by homeostasis model assessment–insulin resistance (HOMA-IR), leptin-to-adiponectin (L/A) ratio, and homeostasis model assessment–adiponectin (HOMA-AD). RESULTS In patients with FELi below the median value (corresponding to the group with increased proximal sodium reabsorption) and higher insulin resistance as measured by HOMA-IR, pulse wave augmentation indexes were significantly higher—AIxP (99.4% vs. 86.2%; P = 0.007), AIxC1 (159.4% vs. 144.2%; P = 0.04), and AIxC2 (36.1% vs. 28.3%; P = 0.02), than in patients with lower insulin resistance. The same trend was observed in relation to L/A ratio—AIxP (98.7% vs. 87.1%; P = 0.005), AIxC1 (158.6% vs. 144.5%; P = 0.02), and AIxC2 (35.6% vs. 28.5%; P = 0.01) and HOMA-AD—AIxP (99.7% vs. 83.8%; P = 0.001), AIxC1 (160.5% vs. 140.3%; P = 0.007), and AIxC2 (36.6% vs. 26.3%; P = 0.003). Such relationships were not observed in patients with FELi above the median value. CONCLUSIONS In the hypertensive population with prevailing sodium intake, insulin resistance and increased sodium reabsorption in proximal tubules may affect arterial wall function.

Artificial urinary sphincter (AUS) implantation is the treatment of choice for male urinary incontinence (UI). The aim of the present study was to evaluate treatment outcomes of UI in men using an AUS with a cuff placed around the prostatic urethra.Forty-three men with preserved prostatic urethra were selected for AUS implantation due to UI. Twenty patients had the cuff implanted around the prostate using the retropubic approach (Group 1), and 23 had the cuff placed around the bulbous urethra (Group 2). Both groups were compared in terms of continence quality as well as intra- and postoperative complications.The groups were comparable with respect to age and duration of follow-up. Median time to complications was 90.3 and 10.7 months in Group 1 and Group 2, respectively (The analysis indicates that cuff placement around the prostatic urethra results in better continence and is characterised by fewer complications. This method is dedicated for patients who have not had the prostate gland removed. Due to the retrospective nature of this analysis and small groups of patients, it is not possible to formulate ultimate recommendations.

Bariatric surgery is considered as a first line treatment in extreme obese patients to achieve a reduction in health risks. However, after surgical procedure obese patients with normal blood pressure (BP) levels still present residual risk, which may be partly related to lack of correction of BP profile and variability. Aim: To evaluate short (10 days) and mid-term (6 months) changes of mean values, profile and variability of BP after bariatric surgery in extremely obese patients with and without hypertension. Materials & methods: A follow-up of cross-sectional study was conducted in 90 obese patients (aged 41.7 ± 11.3, BMI = 46.7 ± 5.7 kg/m2), who met the eligibility criteria and underwent bariatric surgery. Each patient underwent 24-h ambulatory BP monitoring with profile and variability estimation before, 10 days and 6 months after the intervention. Results: Sixty-seven (74.4%) patients had hypertension. Significant decrease from baseline in mean values of systolic and diastolic BP in 10 days (p < .005) and 6 months (p < .005) follow-up were observed only in patients with hypertension. Moreover, only hypertensive subjects revealed significant reduction (p < 0,05) from baseline in 24-h systolic and diastolic BP weighted standard deviation and average real variability after surgical procedure. No changes were found in dipping status. Conclusions: Bariatric surgery not only decreased BP levels, but also contributed to reduction in BP variability in early period after intervention mainly in patients with pre-existing hypertension

Introduction The aim of this single centre retrospective study was to analyse the results of second resection (repeat transurethral resection of bladder tumour - reTURBT) after a macroscopically complete resection of T1 urothelial bladder tumour and to identify prognostic factors for absence of residual disease (T0) in the second resection of T1 bladder cancer. Material and methods Patients with T1 bladder cancer diagnosed in a macroscopically complete initial resection who underwent second resection within 12 weeks were included into the retrospective analysis. Based on the presence or absence of residual disease, patients were grouped for further analysis. Univariate and multivariable logistic regressions were performed to identify potential prognostic factors. Results Among the 139 patients who met the inclusion criteria, 96 (69.1%) had no residual disease (T0) and 43 (30.9%) had residual disease in the second resection (including muscle invasive bladder cancer in 2.2%). Adjusted odds ratios (OR) of T0 status obtained from the final model were as follows: detrusor muscle presence in the first resection (OR 3.05; 95% CI 1.12-8.35, p = 0.03), immediate post-operative intravesical mitomycin C administration after the first TURBT (OR 2.52, 95% CI 1.12-5.68; p = 0.03) and primary bladder cancer setting (OR 2.45, 95% CI 1.10-5.47; p = 0.03). Conclusions Our results add evidence regarding the importance of detrusor muscle presence in the first TURBT. Identification of predictors of T0 status at second resection could help design prospective studies assessing the possibility to avoid re-resection in selected patients with T1 bladder cancer without compromising oncological outcomes.

Isolated systolic hypertension (ISH) is the predominant form of hypertension in the elderly. The pathophysiology includes a plethora of factors; however, the stiffening of large arteries, leading to wider pulse pressure and faster propagation of the pressure pulse wave, are at the core of the disease. It has been shown that higher systolic blood pressure (SBP), pulse pressure, and pulse wave velocity are associated with a greater risk of cardiovascular complications, including a greater risk of dementia. In elderly patients, the relationship between SBP and the risk of mortality starts increasing at about 160 mmHg. A number of clinical trials were performed in populations of patients which included the elderly, however only four trials were specifically dedicated to answer the question of whether the active treatment of ISH (SHEP, Syst-Eur, Syst-China) or treatment of octogenarian hypertensive patients (HYVET) lowers cardiovascular risk in the elderly patient. They all showed that regimens based on thiazide-like diuretics, dihydropyridine calcium channel blockers, or angiotensin-converting enzyme inhibitors are capable of reducing the risk along with the appropriate reduction of SBP. This is widely reflected in the current European guidelines, with the addition of angiotensin receptor blockers. Nevertheless, the debate on the appropriate blood pressure goal is ongoing. However, none of the trials in the elderly had an average SBP lowered to less than 140 mmHg, and the overwhelming evidence suggests that in patients above the age of 70 with overt cardiovascular disease, a SBP less than 130 mmHg may be associated with an increase in risk.

The United Nations (UN) has published a Policy Brief on the impact of the Coronavirus Disease 2019 (COVID-19) that identifies policies and responses to protect older adults. Our objective was to summarize actions, health policies and clinical guidelines adopted by six European countries (Belgium, France, Italy, Poland, Spain and United Kingdom) during the pandemic, and to assess the impact of national policies on reducing adverse effects of the COVID-19 pandemic in older populations.Reports by geriatricians on the measures and actions undertaken by governmental institutions in each country between March and July 2020, as well as the role of primary care during the pandemic, covered three areas: (a) general health strategies related to the pandemic; (b) impact of COVID-19 on health inequity; and (c) initiatives and challenges for the COVID-19 pandemic and beyond.In the six countries, COVID-19 mortality in nursing homes ranged from 26 to 66%. Although all countries endorsed the World Health Organization general recommendations, the reports identified the lack of harmonized European guidelines and policies for nursing homes, with competencies transferred to national (or regional) governments. All countries restricted visits in nursing homes, but no specific action plans were provided. The role of primary care was limited by the centralization of the crisis in hospital settings.The older population has been greatly affected by COVID-19 and by the policies initiated to control its spread. The right to health and dignity are transgenerational; chronological age should not be the sole criterion in policy decisions.

The study aimed to compare arterial and echocardiographic parameters in subjects with newly diagnosed masked (MH) or white-coat hypertension (WCH) to subjects with sustained normotension or sustained hypertension, defined according to the 2014 European Society of Hypertension practice guidelines for ambulatory blood pressure (BP) monitoring. We recruited 303 participants (mean age 46.9 years) in a family-based population study. SpaceLabs monitors and oscillometric sphygmomanometers were used to evaluate ambulatory and office BP, respectively. Central pulse pressure (PP) and aortic pulse-wave velocity (PWV) were measured with pulse-wave analysis (SphygmoCor software). Carotid intima-media thickness (IMT) and cardiac evaluation were assessed by ultrasonography. Analysing participants without antihypertensive treatment (115 sustained normotensives, 41 sustained hypertensives, 20 with WCH, 25 with MH), we detected significantly higher peripheral and central PP, PWV, IMT and left ventricular mass index in hypertensive subgroups than in those with sustained normotension. The differences between categories remained significant for peripheral PP and PWV after adjustment for confounding factors, including 24 h systolic and diastolic BP. Participants with WCH and MH, defined according to strict criteria, had more pronounced arterial and heart involvement than normotensive participants. The study demonstrates a high prevalence of these conditions in the general population that deserves special attention from physicians.

Recommendations of the Polish Society of Hypertension Experts: Marcin Adamczak, Ludwina Szczepaniak-Chichel, Marzena Chrostowska, Danuta Czarnecka, Grzegorz Dzida, Krzysztof J. Filipiak, Jerzy Gąsowski, Jerzy Gluszek, Stefan Grajek, Tomasz Grodzicki, Kalina Kawecka-Jaszcz, Beata Wozakowska-Kaplon, Beata Begier-Krasinska, Jacek Manitius, Malgorzata Myśliwiec, Anna Niemirska, Aleksander Prejbisz, Danuta Pupek-Musialik, Grazyna Brzezinska-Rajszys, Katarzyna Stolarz-Skrzypek, Agnieszka Szadkowska, Tomasz Tomasik, Krystyna Widecka, Andrzej Wiecek, Adam Windak, Jacek Wolf, Tomasz Zdrojewski, Aleksandra Żurowska

Many researchers have found a correlation between tortuous arteries and development of aneurysms in cerebral arteries. However, there are no studies analyzing the impact of tortuosity on risk of subarachnoid hemorrhage (SAH) occurrence. Therefore, we decided to determine whether tortuosity of the anterior cerebral artery can be related to the rupture of anterior communicating artery aneurysm and to severity and treatment outcome of SAH.We retrospectively analyzed anterior cerebral artery anatomy of 121 patients with anterior communicating artery aneurysms. From patients' medical records, we obtained their history including previous and current diseases and medications. For each patient we calculated relative length, sum of angle metrics, triangular index, product of angle distance, and inflection count metrics.Patients with SAH had significantly higher relative length (0.70 ± 0.19 vs. 0.63 ± 0.22; P = 0.03) and significantly lower inflection count metrics (0.10 ± 0.08 vs. 0.16 ± 0.19; P0.01), respectively. In multivariate logistic regression analysis, after adjustment of all possible confounders, diabetes mellitus (odds ratio [OR], 0.154; 95% confidence interval [CI], 0.032-0.553; P0.01) and higher inflection count metrics (OR, 0.604; 95% CI, 0.357-0.909; P = 0.042) remained independently associated with lower risk of SAH. We also found an independent correlation between aneurysm dome size (R = -0.289; P = 0.02) and triangular index (R = 0.273; P = 0.03) and Glasgow Coma Scale score on admission.Higher anterior cerebral artery tortuosity might be a protective factor against anterior communicating artery aneurysm rupture.

Shape and density of intracerebral hemorrhage (ICH) are associated with a higher risk of poor treatment outcome. However, methods of assessment for the features are still inconclusive. Therefore, we decided to measure ICH shape irregularity using shape factors to achieve objective results.We retrospectively analyzed 48 patients with spontaneous ICH confirmed by head computed tomography (CT) scan. We obtained detailed medical history and blood test results from medical records. On admission patients were assessed using Glasgow Coma Scale score, and on discharge patients were assessed using Glasgow Outcome Scale (GOS) score. GOS score of less than 3 was defined as poor outcome. For each slice of CT scan with visible ICH, we extracted its contour and calculated the fractal dimension (FD), compactness (C), and Fourier factor (FF). We also calculated the circle factor (CF), which was defined as the contour perimeter/perimeter of the biggest circle that can be inscribed into the contour, and density heterogeneity, defined as the variance of pixel density.A total of 28 patients (58.33%) had poor treatment outcome. Those patients had significantly higher C (0.71 ± 0.09 vs. 0.59 ± 0.09; P0.01), FD (1.42 ± 0.12 vs. 1.27 ± 0.09; P0.01), and CF (3.59 ± 0.92 vs. 2.63 ± 0.63; P 0.01). In multivariate logistic regression analysis, FD (odds ratio, 4.176; 95% confidence interval, 1.551-15.577; P = 0.012) remained independently associated with higher risk of poor treatment outcome.Each of the shape descriptors, except FF, was associated with treatment outcome after ICH. FD can be used as an independent predictor of outcome.

Background Axial spondyloarthritis (axSpA) is characterized by significant bone loss caused by dysregulation of physiological bone turnover, possibly resulting from intensified differentiation of osteoclasts. The aim of this study was to reevaluate the levels of osteoclastogenesis-mediating factors: soluble RANKL, M-CSF, OPG and other cytokines in sera of untreated, with sDMARDs and/or bDMARDs, axSpA patients and to test whether these sera influence differentiation of healthy monocytes towards osteoclast lineage. Methods Bone remodeling molecules (RANKL, M-CSF, OPG, IL-6, OSM, IL-17A, TGFβ, and TNFα) were evaluated in 27 patients with axSpA and 23 age and sex-matched controls. Disease activity (BASDAI, ASDAS) and inflammatory markers (ESR, CRP) were assessed. Monocytes obtained from healthy individuals were cultured in vitro in presence of sera from 11 randomly chosen axSpA patients and 10 controls, with addition of exogenous M-CSF and/or RANKL or without. Osteoclastic differentiation was assessed analyzing osteoclast markers (cathepsin K and RANK at mRNA level) and with osteoclast-specific staining. Results axSpA patients’ sera levels of soluble RANKL were significantly lower and M-CSF, IL-6, OSM, IL-17A and TNFα significantly higher in comparison to controls, whereas of OPG and TGFβ were comparable in both groups. Numbers of generated in vitro osteoclasts and cathepsin K mRNA levels did not differ between cultures supplemented with sera of healthy and axSpA patients, both in the absence and presence of M-CSF. Instead, addition of exogenous RANKL boosted osteoclastogenesis, which was significantly higher in cultures with axSpA sera. Furthermore, sera from axSpA patients induced substantially higher levels of RANK mRNA, independently of M-CSF and RANKL stimulation. Conclusion We show that, paradoxically, serum levels of soluble RANKL observed in axSpA are in fact significantly lower in comparison to healthy blood donors. Our results indicate that sera of axSpA patients - in contrary to healthy subjects - contain circulating, soluble factors (presumably IL-6, OSM, IL-17A, TNFα and others) able to stimulate healthy monocytes responsiveness to even relative low RANKL serum levels, by inducing high RANK mRNA expression and - as a net effect - boosting their osteoclastogenic potential. We suggest also that locally produced RANKL in axSpA may induce overactive osteoclasts from their precursors.

Arterial hypertension is a prevalent disease with great harming potential. After the age of 55 years the remaining lifetime risk of hypertension amounts to 90%. Despite the constant advances some important issues such as the cut-off blood pressure for the initiation of antihypertensive therapy or the therapeutic goal are debated. In this review, we present - based on the available literature - the current concepts concerning the pathophysiology, epi-demiology and antihypertensive therapy in patients aged 65 years or older. The pathophysiology of hypertension in older patients in principle rests on stiffening of large conduit arteries, which leads to greater systolic and lower diastolic blood pressure. This in most older patients results in isolated systolic hypertension. Additionally most of these patients have low-renin hypertension. Data from large-scale clinical trials indicate that therapy of such individuals with thiazide-like diuretics and long-acting dihydropiridine calcium channel blockers as first-line medications reduces risk of complications. Based on results of recently published trials, meta-analyses, and prospective observations, the optimal on-treatment blood pressure values for most older hypertensive patients should be set within the 130-139 mmHg range. At present, lower values of standard office blood pressure in this group of patients have not been shown to be associ-ated with additional benefits, and may be associated with a greater risk of adverse events. In conclusion, we recommend that for most patients aged 65 years or more, standard office systolic blood pressure should be cautiously reduced to within 140 and 130 mmHg, preferably with a thiazide-like diuretic, long acting dihydropiridine calcium channel blocker or their combination.

INTRODUCTION A different clinical course and pattern of skeletal involvement in peripheral and axial spondyloarthritis (SpA) suggests a distinct pathophysiology of these 2 phenotypic manifestations of SpA. Monocytes, as part of the innate immune system, seem to play an important role in the pathogenesis of SpA, but the exact inflammatory pathways remain to be elucidated. Regulatory T lymphocytes (Treg) and Th17 lymphocytes are also known to influence proinflammatory and anti‑inflammatory reactions. OBJECTIVES The aim of our study was to compare the absolute numbers of monocyte subpopulations, Treg, and Th17 lymphocytes with clinical measures of disease activity in patients with peripheral and axial SpA. PATIENTS AND METHODS We enrolled 21 patients with peripheral SpA and 27 patients with axial SpA diagnosed according to the Assessment of SpondyloArthritis International Society classification criteria, as well as 23 healthy controls. Patients were under 45 years, naive to synthetic and biological disease‑modifying antirheumatic drugs and without the administration of systemic glucocorticoids. The absolute numbers of classical, intermediate, nonclassical monocytes, Treg, and Th17 in peripheral blood were analyzed. Disease activity was assessed using the Ankylosing Spondylitis Disease Activity Score (ASDAS-CRP), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), and Disease Activity Score 28 (DAS28). RESULTS In patients with SpA, the number of circulating nonclassical monocytes was decreased in comparison with controls. Only in the peripheral SpA group, a significant negative correlation was found between the concentration of nonclassical monocytes and DAS28 and the number of swollen joints. The 3 groups did not differ in terms of the concentrations of classical or intermediate monocytes and Treg or Th17 lymphocytes. CONCLUSIONS Nonclassical monocytes may play a role in induction and perpetuation of peripheral joint inflammation, at least in peripheral SpA, as cells infiltrating the synovium.

Hypertension is the leading cause of morbidity and mortality among the older adults worldwide. Pathophysiology of hypertension in old age has been linked to the large arterial remodelling and stiffness. This is followed by concentric hypertrophy of the arterioles and baroreceptor dysfunction. The process leads to increase of systolic (SBP) and, after 5th decade, decrease of diastolic (DBP) blood pressure, with the bulk of the hypertension-related risk associated with SBP rather than DBP. However, the exact SBP value that should constitute the threshold for the diagnosis of isolated systolic hypertension has been debated. On one hand, a constant and linear relationship between systolic blood pressure and risk of complications has been implied. On the other hand, some experts point to the possibility of age-stratified cut-off values. When assessing the results of outcome trials in especially the oldest old, the absolute benefit is of paramount importance, when a greater relative benefit does not necessarily translate into less patients who need to be treated for a given period of time to avoid one event, and remaining life expectancy may be less than ten years. The latter issue is also of importance when generalisability of the clinical trial results is concerned. Further, especially in patients aging without success, burdened with multiple chronic diseases and poorly functioning, we need to take into account the average remaining life expectancy, their cognitive and functional capacity, comorbidities, polypharmacy together with patients’ preferences. Whenever possible, a “de-prescribing” model of hypertension management in old adults may have some merit.

Tortuosity of blood vessels is a common angiographic finding that may indicate systemic disease and can be correlated with vascular pathologies. In this work, we determined whether patients with and without internal carotid artery (ICA) aneurysm presented with differences in its tortuosity descriptors. We retrospectively analysed data of 298 patients hospitalized between January 2014 and June 2018. For each patient&rsquo, s imaging data, we extracted a curve representing the ICA course and measured its Relative Length (RL), Sum of Angle Metrics (SOAM), Product of Angle Distance (PAD), Triangular Index (TI), and Inflection Count Metrics (ICM). We found that patients with an ICA aneurysm had significantly lower RL (0.46 &plusmn, 0.19 vs. 0.51 &plusmn, 0.17, p = 0.023) and significantly higher SOAM (0.39 &plusmn, 0.21 vs. 0.32 &plusmn, 0.21 p = 0.003), PAD (0.38 &plusmn, 0.19 vs. 0.32 &plusmn, 0.21, p = 0.011), TI (0.30 &plusmn, 0.11 vs. 0.27 &plusmn, 0.14, p = 0.034), and ICM (0.30 &plusmn, 0.16 vs. 0.22 &plusmn, 0.12, p &lt, 0.001). We found that that patients who presented with a subarachnoid hemorrhage had significantly higher PAD (0.46 &plusmn, 0.22 vs. 0.35 &plusmn, 0.20, p = 0.024). In conclusion, higher tortuosity of ICA is associated with ICA aneurysm presence.

See related article, pp 1110–1114 Over the past 60 years, we learnt not only to appreciate the risk associated with elevated blood pressure (BP), but also to implement efficient therapeutic modalities capable of markedly reducing the risk of cardiovascular complications. However, such seemingly simple matter as deciding the exact therapeutic goals to which BP should be lowered to reduce the risk of events is probably as far from being universally agreed on as it must have been in the fifties. The recent versions of major guideline documents1,2 indicate that for low- to moderate-risk adults

Importance of the field: Populations, the world over, age. Prevalence of hypertension increases with advancing age. Despite the advances over the past 30 years, there are still unresolved issues regarding antihypertensive therapy in the elderly. Areas covered in this review: The present review discusses the available evidence supporting treatment of hypertension in the elderly. What the reader will gain: In the 1980s and 1990s, a number of trials were performed and proved that active treatment of hypertension in individuals above the age of 60 - 65 years, compared with placebo or no treatment, reduces the risk of complications. In the 1990s, the same was proven in patients specifically affected with isolated systolic hypertension, the predominant form of hypertension in the elderly. The subsequent years witnessed the publication of trials that showed that most antihypertensive drugs are capable of substantially reducing risk. Finally, treatment of hypertension in the very elderly was proven to be beneficial. Take home message: In spite of these advances, we still lack evidence in elderly patients with mild isolated systolic hypertension and are therefore in need of a properly designed, randomized, placebo-controlled trial. ispartof: Expert Opinion on Pharmacotherapy vol:11 issue:16 pages:2609-2617 ispartof: location:England status: published

Left atrial enlargement (LAE) is a risk factor for cardiovascular complications and death. In hypertensive patients, LAE is usually due to left ventricular (LV) hypertrophy and diastolic dysfunction. We aimed to identify factors associated with LAE in patients with increased and normal left ventricular mass index (LVMI) with reference to pulsatile and steady components of blood pressure (BP). The study was carried out as a cross-sectional observation. In a group of inhabitants of suburban area of Cracow, Poland, we measured office, ambulatory and central BP, carotid-femoral pulse wave velocity (PWV), as well as echocardiographic indices and gathered anthropometric data, information on habits and relevant medical history. Further, with division according to sex-stratified dichotomised LVMI, we performed correlation analysis to identify possibly significant relations between measures of left atrial volume and other studied parameters. We also fitted regression models in order to assess the respective value of steady and pulsatile BP components as factors related to measures of left atrial volume. The mean age of 205 patients (136 females—66%) was 53.6 ± 8.3 years. We found higher values of PWV, office, ambulatory and central BPs in the group of LVMI above median value. This group had also greater left atrial volume index (LAVI), which correlated with LVMI (r = 0.36, P

INTRODUCTION Patients with resistant hypertension (RHT) are at high risk for coronary artery disease (CAD) and cerebrovascular disease (CVD), compared with the general hypertensive population. OBJECTIVES The aim of the study was to evaluate factors associated with RHT in a large sample of hypertensive patients under the care of general practitioners and specialists in Poland. PATIENTS AND METHODS We included 12 375 patients (mean age, 64.0 ±12.3 years; age range, 18-98 years; women, 59%) with hypertension treated for at least 1 year. Patients were divided into 3 groups: with controlled hypertension, uncontrolled hypertension (not fulfilling the criteria for RHT), and RHT. RESULTS Controlled hypertension, uncontrolled hypertension, and RHT were found in 47.3%, 27.9%, and 24.7% of the patients, respectively. The RHT rate was higher in patients visiting specialist offices (29.8%) and in patients with diabetes (32.5%), CAD (31.5%), CVD (33.3%), and impaired renal function (31.9%). Patients with RHT were characterized by the highest rate of high (23.5%) and very high (60.5%) added cardiovascular risk. An underuse of preferred antihypertensive drug combinations and aldosterone antagonists in patients with uncontrolled hypertension and RHT was observed. In a multivariate analysis, RHT was independently associated with male sex, higher pulse pressure, metabolic syndrome, diabetes, CAD, CVD, diseases requiring treatment with nonsteroidal anti-inflammatory drugs and an estimated glomerular filtration rate of less than 60 ml/min/1.73 m2. CONCLUSIONS The vast majority of patients with RHT carry a high or very high cardiovascular risk. In addition, the underuse of preferred antihypertensive drug combinations and aldosterone antagonists has been observed.

Frailty syndrome (FS) and cognitive impairment are associated with an increased risk of falls, disability, hospitalization and death. We investigated prognostic meaning of FS and cognitive impairment in persons ≥ 65 years, living in 2 nursing homes. Information about the health status of patients was gathered from history, medical documentation, test assessing FS, according to the Canadian Study of Health and Aging-Clinical Frailty Scale (CSHA-CFS) and the Mini-Mental State Examination (MMSE). The study group included 66 women and 20 men, between 66 and 101 years of age (mean ± S.D.=83.8 ± 8.3 years). The frequency of severe frailty (CSHA-CFS=7) among the elderly living in nursing homes was 34.9%, while severe cognitive impairment (MMSE

Objective To examine yttrium-90 distribution 1 and 72 h following its injection into a knee joint in patients with rheumatoid arthritis (RA). Methods In 14 RA patients we injected yttrium-90 into the affected knee joint using lateral approach. To assess the radioisotope distribution in the joint, the superimposed sequential SPECT and CT imaging was performed 1 and 72 h after the injection. We analyzed the percentage of radioisotope distribution in three predefined compartments of the knee joint (lower, upper medial, upper lateral). Results After 1 and 72 h, the mean percentage distributions were, respectively, 7.14 and 23.07 % in lower; 21.42 and 15.38 % in upper medial, and 71.42 and 61.53 % in upper lateral compartment. The percentage of isotope deposition did not change significantly with time in any of the compartments (all p > 0.26). The deposition of isotope, both at 1 and 72 h, was significantly greater in upper lateral compartment, where the injection was performed, than in all other compartments (all p < 0.05). Conclusions Using the SPECT/CT hybrid method, we proved that the majority of isotope is located at the compartment adjacent to the injection. Two injections targeting different compartments might improve the clinical efficacy of the procedure.

To examine changes in serum levels of the bone remodelling molecules dickkopf-1 (Dkk-1), sclerostin, wingless-type protein-3a (Wnt-3a), and bone morphogenetic protein-7 (BMP-7) during 6 months of anti-tumour necrosis factor (anti-TNF) treatment in ankylosing spondylitis (AS) patients with high disease activity.We included 40 patients with axial AS: 20 patients with high disease activity were assigned to treatment with TNF inhibitor and 20 with low disease activity were assigned to non-steroidal anti-inflammatory drug (NSAID) treatment. Markers of bone remodelling and inflammation were assessed at baseline and after 6 months.In the TNF inhibitor-treated group Dkk-1 decreased significantly from 196.8 pg/mL [95% confidence interval (CI) 94.1-399.0] to 116.3 pg/mL (95% CI 38.0-301.6) and BMP-7 increased significantly from 1.4 pg/mL (95% CI 0-23.0) to 20.3 pg/mL (95% CI 4.9-41.3). There was a significant negative correlation between Dkk-1 and BMP-7 at 6 months (r = -0.64, p = 0.004) in this group. Non-parametric regression analysis adjusted for disease duration, age, sex, baseline modified Stoke's Ankylosing Spondylitis Spine Score (mSASSS), and baseline C-reactive protein (CRP) confirmed a statistically significant effect of treatment on time-related changes of Dkk-1 and BMP-7. Erythrocyte sedimentation rate (ESR), CRP, and also the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) score decreased significantly in the anti-TNF-treated group.Among the potential biomarkers of bone remodelling in AS, Dkk-1 and BMP-7 displayed significant time alterations and correlative interactions during anti-TNF treatment.

The current study aims to check the relationship between parameters derived from brachial blood pressure, the carotid artery intima-media thickness (IMT), pulse wave velocity (PWV) and mean cerebral blood flow velocity (mCBFV) in the middle cerebral artery (MCA). In consecutive adult outpatients we recorded the brachial systolic blood pressure (SBP), diastolic blood pressure (DBP), pulse pressure (PP), mean arterial blood pressure (MAP), PWV and IMT. mCBFV was assessed using Doppler ultrasound probe applied to the transtemporal window. The mean±s.d. age of 165 patients (50% women) was 56.7±11.8 years. Women and men differed significantly in SBP, PP, total cholesterol and mCBFV. Age (r=−0.44, P

Background and purpose Spontaneous intracerebral haemorrhage (ICH) is the most fatal form of stroke with the highest morbidity and disability rate of all stroke types. Recent data suggest that the genetic background has a sizeable and mostly undiscovered effect on the brain haemorrhage risk. Since the coagulation system is crucial to ICH pathology, we studied the significance of the FGA Thr312Ala polymorphism in two European populations. Materials and methods We genotyped 550 and 224 controls as well as 261 and 242 stroke patients in Polish and Greek populations, respectively. The ICH diagnosis was confirmed by computed tomography. The FGA Thr312Ala polymorphism was analysed using real-time polymorphism chain reaction. Results Both crude and multivariable regression analyses showed that the studied polymorphism is a protective factor in the Polish population under the dominant and additive models of inheritance. Those results did not replicate in the Greek population. The meta-analysis of results from the Polish and the Greek populations proved that FGA Thr312Ala polymorphism affects the risk of ICH in the dominant model of inheritance. Conclusions The FGA Thr312Ala polymorphism affects a risk for ICH in the Polish but not in the Greek population. An advanced meta-analysis of well-designed studies with a significant number of cases might provide useful information of novel polymorphisms, including the FGA Thr312Ala polymorphism, and their role in ICH pathology.

Asymmetric dimethylarginine (ADMA) is associated with endothelial injury. Increased ADMA levels are found in rheumatoid arthritis (RA) and ankylosing spondylitis (AS). We set out to assess the ADMA and symmetric dimethylarginine (SDMA) levels in AS, RA, and healthy controls, and in the anti-TNF treated patients with active AS.In 78AS patients and 29 RA patients who were anti-TNF treatment naive at baseline, along with 23 healthy control subjects, we assessed erythrocyte sedimentation rate (ESR), high-sensitivity C-reactive protein (hsCRP), ADMA, and SDMA. For AS patients, the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), back pain VAS and patient's global activity of disease were calculated. After 6 months, we repeated the assessment in 30 out of the 78 AS patients in whom the anti-TNF treatment was initiated.The baseline mean (SD) plasma ADMA concentration of AS patients was 0.64 (0.19) μmol/l and did not differ from controls (0.65 [0.19] μmol/l, p0.05). In the RA group, ADMA concentration was higher than in controls (0.77 vs. 0.65 μmol/l, p0.05). Both at baseline and at follow-up, ADMA levels correlated positively with BASDAI (R = 0.52, p = 0.02, and R = 0.47, p = 0.04, baseline and follow-up, respectively). Six months of anti-TNF treatment did not influence ADMA concentration (0.51 [0.12] vs. 0.51 [0.11] μmol/l, p = 0.70).An absence of changes in plasma ADMA levels in the anti-TNF treated AS group despite the improvement in disease activity (BASDAI) and inflammation (ESR, CRP) may suggest either a lack of effect, or, even if such an effect were to take place, it needs not imply measurable changes in blood ADMA.

INTRODUCTION Heart failure (HF) in the elderly is frequently associated with limited therapeutic options and may cause severe complications. Unfortunately, these patients are often excluded from clinical trials. OBJECTIVES The aim of the study was to determine the relationship between HF, coexisting diseases, and use of medications in patients of advanced age living in nursing homes. PATIENTS AND METHODS The study group included 79 women and 21 men between 65 and 102 years of age living in 2 nursing homes. Information about the health status of patients was gathered from history and medical records. We conducted a physical examination and, in eligible cases, also an orthostatic test. Comorbidity was assessed using the age‑adjusted Charlson comorbidity index (ACCI). RESULTS The prevalence of HF was 26%. The number of chronic diseases coexisting with HF was remarkably higher than the number of diseases among patients without HF (median, 6 [0-11] vs. 3 [0-8]; P

Falls are a geriatric syndrome which affects the physical and psychological well-being of the aged. So far, in Poland there have not been any population-based data on the prevalence of falls among the elderly. The aim of this analysis was to assess the prevalence of falls, their circumstances and consequences in the Polish population aged 65 years and older in comparison to younger respondents aged 55-59 years, and the relation of falls to visual and hearing deficits. Mean age of the 4920 elderly subjects (51.6% men) was 79.4±8.7 years. Falls in the past year were reported by 10.4% of the younger and 19.1% of the older subjects. In both groups falls occurred more frequently in women (11.9% vs. 8.7%, p=0.03 in the younger and 22.7% vs. 13.2%, p

See related article, pp 205–211 It has been estimated that 124 cases of breast cancer occur annually per 100 000 women in the United States alone, and 23.5 of 100 000 die every year despite the advances in therapeutic options that took place over the past decades. The absolute estimates for 2011 show 230 480 new cases, with 39 520 prospected fatal cases.1 This establishes breast cancer as the most frequent malignancy and at the same time the second leading cause of cancer mortality in women. The risk of fatal outcome in women treated for breast cancer is related to cancer biology, which determines the choice of and response to therapy, as well as to comorbid conditions and age. Age plays a special role in epidemiological considerations because it is regarded to be the strongest predictor of both morbidity and mortality in both sexes, irrespective of baseline medical status. However, ways by which ageing affects prognosis in a patient diagnosed with breast cancer have not yet been fully elucidated. Hypertension is the most important modifiable risk factor for vascular events. According to the World Health Organization, it is the top leading cause of death in all societies, irrespective of level of income. Hypertension has been found to lead to accelerated senescence of the cardiovascular system, a notion confirmed by observations from hypertensive animals of an increased turnover of cells, and reduced half-life of DNA, accompanied by the presence of shorter telomere fragments in kidneys of spontaneously hypertensive rats.2 On the other hand, prevalence of hypertension increases with advancing age, with age-related changes in cardiovascular structure and function, ranging from derangement of paracrine regulation in endothelium to large arterial stiffening, establishing the pathophysiologic background for the age-dependent increase in prevalence of hypertension. The high prevalence of hypertension implies that …