Search

The objective of the present study was to evaluate the effect of dynapenia, central obesity and the presence of chronic diseases in 8-year mortality of community-dwelling older adults.Participants comprised 610 older adults, aged ≥65 years at baseline, who participated in the "Frailty in Brazilian Older People" study carried out in 2008. Baseline data, such as weight, height, waist circumference, muscle strength, sex, self-reported diseases and physical activity, were assessed. Vital status in 2016 was assessed by Mortality Information System database of Campinas. The χThere was a statistical difference between alive and deceased groups for the variables sex, age group, physical activity, waist circumference and dynapenia. Path analysis explored the relationship among the studied variables. Direct paths showed a positive association to mortality for those who presented the combination of more diseases (β = 0.105), male sex (β = 0.108), low physical activity (β = 0.121), low handgrip strength (β = 0.090) and no central obesity (β = -0.143). When indirect paths were concerned, variables "central obesity", the presence of "more diseases" and dynapenia had a mediator role.Central obesity was not positively associated with higher mortality, unless it was associated with the presence of chronic diseases. Dynapenia showed a direct effect on mortality, but not combined with central obesity. The findings of this study shed light on complex relationships between nutritional status and elderly mortality through the use of simple measurements. Geriatr Gerontol Int 2019; 19: 108-112.

To determine the direct and indirect relationships of sociodemographic, emotional and behavioral characteristics of family caregivers of Alzheimer's disease patients who have neuropsychiatric symptoms.A total of 134 family caregivers answered a questionnaire with sociodemographic data, and questions regarding the context of care, Neuropsychiatric Inventory, Zarit Burden Interview, Dementia Management Strategies Scale and the Beck Depression Inventory. A path analysis was used to model the direct and indirect relationships among the selected variables.Being a female caregiver, presenting high levels of burden, a moderate degree of depressive symptoms, distress (Neuropsychiatric Inventory total distress score), active management strategies and criticism management strategies were significantly associated with the total score of neuropsychiatric symptoms. The caregiver burden and use of criticism management strategies were directly related to neuropsychiatric symptoms in older adults with Alzheimer's disease. The use of active management strategies and depressive symptoms of caregivers had indirect relationships with neuropsychiatric symptoms through caregiver burden.Overburdened caregivers and the use of dysfunctional management strategies are associated with a greater presence of neuropsychiatric symptoms in Alzheimer's disease patients. These aspects should be considered when developing interventions for caregivers to manage neuropsychiatric symptoms and overall treatment of patients with dementia. Geriatr Gerontol Int 2018; 18: 1177-1182.

There is still disagreement on whether peritoneal dialysis (PD) should begin with a full dose (Full_Dial) or with incremental doses (Incr_Dial) to compensate for the amount of Kt/V no longer supplied by the residual renal function (RRF). The aim of this study is to assess the effects of an Incr_Dial protocol on the choice of dialysis modality, RRF, and adequacy. The Incr_Dial protocol in our center is as follows: for patients with a glomerular filtration rate (GFR)5 ml min(-1), PD is initiated with two exchanges per day (continuous ambulatory PD (CAPD)) or four sessions per week (ambulatory PD (APD)); and hemodialysis (HD) is initiated with two sessions per week. The PD dose is then increased in proportion to the reduction in the GFR as follows: GFRor =5 and3 ml min(-1)=3 CAPD exchanges or five APD sessions; GFR3 ml min(-1)=full dialysis dose (Full_Dial). The effects of the Incr_Dial protocol on the choice of dialysis modality were assessed on 87 patients (pts) (age: 69.3+/-13.1 years) who initiated dialysis between 1 January 2004 and 31 May 2007. The effects of Incr_Dial on RRF and dialytic adequacy were assessed in 11 pts treated with two CAPD exchanges per day for a total of 106 months (mean+/-s.d. 9.7+/-6.5), and then treated with three CAPD exchanges per day for an additional 105 months (9.4+/-8.3). The use of Incr_Dial determined the choice of PD in 27 of 44 pts (61.4%) without indications or contraindications to HD or PD. CAPD was chosen by 20 of these pts (74.1%), whereas APD was preferred by 6 of the 8 pts switched from Incr_Dial to Full_Dial. During Incr_Dial, a significant reduction in the loss of GFR of 2.4+/-3.1 ml min(-1) year(-1) was observed when compared to the pre-dialysis period. Incr_Dial allowed for adequate clearance, as confirmed by the Kt/V (2.07+/-0.2), protein nitrogen appearance (1.17+/-0.13), and biochemical parameters. Ultrafiltration (UF) with icodextrin (772+/-166 ml per exchange) provided a daily UF of 517+/-296 ml day(-1) and remained unchanged when the duration of the dwell time increased significantly from 12.3+/-1.4 to 17.5+/-2.6 h.

The aim of this study was to investigate the relationship between subjective well-being, functional independence and lower-limb performance (muscle strength, gait velocity and balance) among elderly people undergoing outpatient follow-up, stratified by sex and age groups.We evaluated 125 elderly people, aged 60 years and over, who received care at a geriatric outpatient clinic. The instruments used were: 1) Functional Independence Measure (FIM) to evaluate functional dependence; 2) Short Physical Performance Battery (SPPB) to measure physical performance; and 3) Subjective Well-Being (SWB) with questions about health and satisfaction with life.A convenience sample was used, with predominance of females (who had greater functional impairment). The Spearman correlation coefficients for subjective well-being and the performance tests varied from -0.16 to 0.31 for men and -0.09 to 0.29 for women, therefore there were no differences between the sexes. However, the older participants had a higher level of satisfaction than the younger participants. Perceived health was also more satisfactory among the older participants, however comparative perceived health was better among the elderly participants with moderate to good physical performance.The results suggest that older individuals have greater satisfaction with life and better perceived health. Moreover, good physical performance was an important variable for better perceived health when compared to other people.

Washed guinea-pig spermatozoa from the vas deferens re-acquired progressive motility within 1-2 min of incubation in minimal culture medium containing pyruvate and lactate. When glucose was added, either at the beginning or after 15 min of incubation, the cells showed stimulated motility (increased straight-line velocity, linearity and beat-cross frequency, P less than 0.01). Re-acquisition of progressive motility was preceded by a significant (P less than 0.005) transient increase in sperm concentration of cyclic adenosine 5'-phosphate (cAMP) with or without glucose in the medium. Papaverine caused another large significant (P less than 0.001) increase in cAMP concentration; and 5.56mM glucose with papaverine caused a further stimulation in cAMP beyond that with papaverine alone (P less than 0.005). Although 0.05 or 5.56mM glucose plus alpha-chlorohydrin stimulated sperm motility, they did not further stimulate the increase in cAMP after 30 s of incubation. Thus, there was no apparent correlation between the glucose-stimulating effect on sperm motility and the enhancement of cAMP at 30 s. However, there was a close correlation between glucose-stimulated motility and enhancement of ATP (P less than 0.05) by glucose even under incubation conditions in which glucose caused the Crabtree effect (decrease in respiration rate).

The timing of creation of the first permanent vascular access is crucial to the clinical history of haemodialysis patients. Our strategy is to create vascular access early enough to allow its maturation before the start of the treatment.Aim of the study is to evaluate patency of primary A-V fistulas in patients treated between 1985 and 2000 in our dialysis unit. One hundred and thirty A-V fistulas created before haemodialysis treatment (range 10-540 days) and used at its beginning (pre-HD group) are compared with 74 A-V fistulas created and/or used after the start of the haemodialysis treatment (post-HD group).Pre-HD group fistulas resulted in higher patency rate than the post-HD group, immediately at the start of the treatment (94.6% vs. 86.5%, p0.05), at 6 months (89.2% vs. 75.6%, p0.025), at 12 months (84.5% vs. 64.6%, p0.005), at 24 months (77.2% vs. 54.8%, p0.005).A-V fistula is to be preferred in the choice of primary vascular access for chronic haemodialysis patients. It should be created early enough before the beginning of the treatment (when serum creatinine reaches 6 to 7 mg/dL). This planning avoids central venous catheter placement, preserves vessels and the choice of the best surgical option thus resulting in a better fistula survival.

Icodextrins (Icos) produce constant linear ultrafiltration (UF). This effect allows Icos to replace glucose during long dwells in continuous ambulatory peritoneal dialysis [CAPD (nighttime)] and automated peritoneal dialysis [APD (daytime)]. However, the effectiveness of Icos in producing UF (IcoUF) is limited by lymphatic reabsorption, whose extent depends partly on posture and physical activity. This paper aims to assess whether the difference in posture and physical activity between daytime dwells in APD and nighttime dwells in CAPD affects IcoUF. Patients undergoing first treatment were retrospectively examined. Ten patients were on CAPD [4 males, 6 females; average age, 73.0 +/- 13.4 years; body surface area (BSA), 1.63 +/- 0.21 m2; total volume per day, 5.6 +/- 1.9 L], and ten were on APD (7 males, 3 females; average age, 67.7 +/- 9.8; BSA, 1.75 +/- 0.22 m2; total volume per night, 10.5 +/- 0.9 L). Ultrafiltration was assessed for seven consecutive days preceding a peritoneal equilibration test (PET) and collection of diuresis. In both groups, 3 patients had no diuresis, and the difference between CAPD and APD was not significant (625 +/- 762 mL vs 780 +/- 878 mL). Moreover, no significant difference was seen in 4-hour dialysate-to-plasma creatinine (D/P) between CAPD (0.65 +/- 0.12) and APD (0.64 +/- 0.05). Dwell times with Icos were shorter in CAPD than in APD (11.5 +/- 1.8 hours vs 14.8 +/- 0.5 hours, p0.0005), but the fill volume was not significantly different (1760 +/- 286 mL vs 1790 +/- 249 mL). Water excretion owing to diuresis and dialysis [total water excretion (TWE): 1619 +/- 497 mL CAPD vs 1762 +/- 736 mL APD] and dialytic UF (363 +/- 443 mL CAPD vs 748 +/- 479 mL APD), which is not linked to Icos, were not significantly different between the two groups. The IcoUF and the percentage of IcoUF to TWE were significantly higher in CAPD compared to APD [631 +/- 253 mL (44% +/- 27%) vs 234 +/- 215 mL (19% +/- 19%), p0.001 (p0.05)]. In conclusion, an upright posture and physical activity seem to produce less IcoUF in APD despite the longer dwell. These factors could, indeed, produce greater intraperitoneal pressure, resulting in increased lymphatic reabsorption during a daytime dwell.

The calculation of Kt/V and creatinine clearance per 1.73 m2 of body surface area (CrCl/1.73 m2 of BSA) varies according to whether the post- or pre-nightly dialysis treatment (NDT) values of the serum urea (sUrea), serum creatinine (sCreat), and body weight (BW) parameters are used. The purpose of this paper is to determine the difference between Kt/V and CrCl/1.73 m2 of BSA, calculated using the pre- and post-NDT values, and any correlation of such differences with different automated peritoneal dialysis (APD) methods. We took into consideration patients on APD treated using the tidal method with four different techniques: NTPD (9 patients; no daytime dwell), NTPD-1 (12 patients; one daytime dwell of 4-7 hours), CTPD (10 patients; one daytime dwell), and CTPD-2 (8 patients; two daytime dwells). Body water (V) and body surface area (BSA) were calculated using the Watson and Du Bois formulas. The percentage difference between pre- and post-NDT using the various methods is not statistically significant, while all the post-NDT parameters are significantly lower than the pre-NDT parameters. Since this difference is greater for sUrea (8.8%) and V (1.1%) than for sCreat (4.1%) and BSA (0.8%), the nightly Kt/V variation (11.2%) is greater than the nightly CrCl/1.73 m2 of BSA variation (5.2%). These variations do not differ significantly among the various methods. For APD, therefore, increase is to be expected in the CAPD targets of 10% and 5% respectively for Kt/V and CrCl/1.73 m2 of BSA calculated using the post-NDT values of sUrea and sCreat and the pre-NDT value of BW.

A sudden-onset chyluria after trauma was evaluated giving evidence of a lymphatic-urinary fistula in the right kidney. Treatment with somatostatin normalized the urinary pattern and the result was maintained even after the discontinuation of the therapy.

The authors present a description of PAR Village, a demonstration project designed to examine the question of whether mothers in residential treatment accompanied by their children have better outcomes than those who enter treatment without their children. Issues related to the treatment of women in substance abuse programs are discussed as an introduction to the structure and purposes of the program. Details of the setting, client selection process, and program philosophy are provided. The workings of program services and treatment elements are described and illustrated by a case example.

Hyperactivated motility was studied in guinea pig spermatozoa. In the presence of the local anesthetic procaine, a high number of sperm cells (64%) showed hyperactivation when incubated in minimal culture medium with pyruvate, lactate, and glucose. Hyperactivated motility was dependent on glucose in the medium. Sperm ATP concentration was increased twofold in hyperactivated sperm when compared to procaine-treated non-hyperactivated cells. cAMP levels were also higher in hyperactivated cells than in control spermatozoa. Thus, in living spermatozoa high levels of ATP appear to be needed to generate hyperactivation. cAMP is present at a high concentration in hyperactivated spermatozoa, therefore a role of cAMP in hyperactivation cannot be excluded. Depletion of external Ca2+ did not inhibit procaine-induced hyperactivated motility. Hence, procaine canceled the requirement of external Ca2+ for sperm to express hyperactivated motility.

There is convincing clinical and experimental evidence to support the notion that lipoprotein(a) [Lp(a)] is atherogenic. Patients undergoing chronic hemodialysis have an increased risk of atherosclerotic cardiovascular complications. In the present study, we investigated the possible relation between the alteration, if any, in serum Lp(a) and coronary artery disease in such patients. The mean serum concentration of Lp(a) tended to be higher in the 64 hemodialysis patients than in the 30 normal controls (15.1 ± 15.2 vs. 9.7 ± 10.4 mg/dl). However the difference did not reach statistical significance. The prevalence of levels above 30 mg/dl was 14% (9/64) and 10% (3/10), respectively, and the difference was also not statistically significant. Eleven hemodialysis patients with coronary artery disease had a significantly higher mean serum concentration of Lp(a) than the unaffected 53 (33.7 ± 18.4 vs. 11.1 ± 11.2 mg/dl, p < 0.001). Elevated levels were present in 63.6% (7/11) and 3.8% (2/53), respectively (p

This study reports on 9 patients suffering from Wegener's granulomatosis (WG) with crescentic GN and severe systemic manifestations. On admission the mean serum creatinine was 10.9 +/- 5.1 mg/dl (4-20 mg/dl); 8 patients were oliguric and required dialysis treatment. Renal biopsy showed crescents in all cases, involving 66 to 100% of glomeruli. Patients were treated with a protocol including: a plasma exchange (PE) course; methylprednisolone; cyclophosphamide; and an antithrombotic agent (defibrotide). Clinical picture and renal function progressively improved in all patients within the first 4 weeks of treatment. After 1 month serum creatinine was 2.7 +/- 0.8 mg/dl and dialysis was no longer needed in any patient. Five relapses occurred in 3 patients 12-26 months after the onset of the disease, while they were still receiving immunosuppressive treatment. At follow-up (22 to 112 months: mean 71) all patients were alive with no clinical signs of disease activity. One patient was on regular dialysis while the others had a serum creatinine of 1.2-2.8 mg/dl (mean 1.9). Our results confirm that crescentic GN associated with WG can be successfully treated even when associated with severe clinical picture and suggest that PE can contribute to control the disease without increasing immunosuppression.

This study reports on 12 patients with acute renal failure due to biopsy-proven rapidly progressive glomerulonephritis and signs of systemic disease in whom antineutrophil cytoplasmic autoantibodies (ANCA) were detected by indirect immunofluorescence (IIF) on alcohol-fixed neutrophils and assessed in serial determinations by ELISA. The diagnosis was: Wegener's granulomatosis in nine patients who showed a diffuse cytoplasmic pattern at IIF (c-ANCA), and microscopic polyarteritis in three where a perinuclear pattern (p-ANCA) was seen. All patients underwent a course of plasma exchange - PE - (3-10 sessions per patient) associated with steroids and cyclophosphamide. The ANCA titer dropped steeply during PE in all cases and was followed by disappearance of systemic symptoms and renal function improvement within four weeks. After a follow-up period of 50 +/- 31.2 months all patients were alive without signs of disease activity; ten had stable renal function, with serum creatinine 1.8 +/- 0.7 mg/dl; two had entered regular dialysis treatment after 44 and 82 months. Our results suggest that the rapid removal of ANCA by means of PE can help control disease activity and reduce the risk of death or end-stage renal disease.

Androgenic steroids have been shown to enhance erythrocyte 2,3-DPG production in vivo and in vitro, and to stimulate the pentose shunt oxidative reactions in vitro. Furthermore, a 3 beta- and a 17 beta-hydroxysteroid dehydrogenase have been identified in red cells. The present study was carried out to explore a cumulative effect of androgens on glycolysis and androgen reduction in human erythrocytes in vivo following a single 50 mg oral dose of 17 beta-hydroxy-2 (hydroxymethylene)-17 methyl-5 alpha-androstan-3-one (oxymetholone). The rate of erythrocyte glycolysis was measured by quantitative determination of: fructose-1,6-diphosphate (FDP); dehydroxyacetone phosphate (DAP); 2,3-diphosphoglycerate (2,3-DPG); adenosine triphosphate (ATP); and lactate. Serum and erythrocyte steroids were separated by thin layer chromatography. The reduction of 5 alpha-androstan-17 beta-ol-3-one by red cell hemolysate was measured in the presence of NADPH as an index of 3(17)beta-hydroxysteroid dehydrogenase activity. Our results show that oxymetholone administration is followed by the appearance of an unidentified steroid fraction in chromatograms of serum and erythrocytes, simultaneously with the enhancement of glycolysis and of hydroxysteroid dehydrogenase activity in erythrocytes. A direct effect of androgen on erythrocyte metabolism, which is independent of the hormone erythropoietic effect, is discussed.

Iridocyclitis is a common complication of juvenile rheumatoid arthritis. It affects particularly female patients with mono-oligoarthritis. A positivity of ANA-test is usually observed, representing a marker for the disease. The course is chronic, leading potentially to scarring and blindness. The insidious onset, often not parallel to arthritis, requires careful ophthalmologic examination of all patients at risk, in order to achieve early diagnosis and treatment.

Six cases of cerebral venous angioma in children under 8 years of age reported, with respects to their clinical and neuroradiological features. Any attempt of classification is inadequate, due to the protean characteristics of these malformations, wich can be definied - and usually are - upon the base of predominantly angiographic standards, a valuable diagnostic help being provided by the computerized tomographic investigation. The study of cerebral regional blood flow can represent a major instrument when the clinical and morphological aspects of the malformation make an alteration of it suspectable. In the cases we operated on, clinical healing has been obtained; no worsening has been observed in non-operated cases, during a follow-up of 1 to 7 years; only one of our little patients, presenting with an enormous aneurism of Galen's vein, which we regarded as inoperable, died at 9 months of age.

The janus kinases (JAK), extracellular signal-regulated kinases (ERK) and signal transducers and activators of transcription (STAT) pathways have been shown to play a cardioprotective role. We previously gave evidence that melanocortins afford cardioprotection in conditions of myocardial ischemia/reperfusion. Here we aimed to investigate the influence of melanocortins on the JAK/ERK/STAT signaling in cardiac and systemic responses to prolonged myocardial ischemia/reperfusion. Ischemia was produced in rats by ligature of the left anterior descending coronary artery for 30 min. At the end of the 2-h reperfusion, western blot analysis of the cardioprotective transcription factors pJAK2, pERK1/2, pTyr-STAT3 and pSer-STAT3, the inflammatory mediator tumor necrosis factor-α (TNF-α), the pro-apoptotic factors BAX and c-jun N-terminal kinases (pJNK), the anti-apoptotic protein Bcl-XL, as well as of the cardioprotective enzyme heme oxygenase-1 (HO-1), was performed in the left ventricle and spleen. Intravenous treatment, during coronary artery occlusion, with the melanocortin analogs [Nle(4), D-Phe(7)]α-melanocyte-stimulating hormone (NDP-α-MSH) and adrenocorticotropic hormone 1-24 [ACTH-(1-24)], induced a left ventricle up-regulation of pJAK2, pERK1/2 and pTyr-STAT3 (JAK-dependent), and a reduction in pJNK and TNF-α levels; these effects of NDP-α-MSH and ACTH-(1-24) were associated with over-expression of the pro-survival proteins HO-1 and Bcl-XL, and marked decrease of the myocardial infarct size. Melanocortin treatment did not affect left ventricle pSer-STAT3 (ERK1/2-dependent) and BAX levels. In the spleen, NDP-α-MSH and ACTH-(1-24) induced similar effects on the expression of the above transcription factors/proteins, except for pERK1/2 (down-regulated) and HO-1 (unaffected). Blockade of JAK and ERK pathways with AG490 and U0126, respectively, abrogated the myocardial infarct size reduction by NDP-α-MSH. These results indicate that melanocortins inhibit local and systemic inflammatory and apoptotic cascades triggered by prolonged myocardial ischemia/reperfusion, with consequent reduction in myocardium infarct size, seemingly via activation of the JAK/STAT signaling and with modulation of an ERK (STAT unrelated) signaling pathway.