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Susanne Kristine Aune,1,2 Ragnhild Helseth,1,3 Are A Kalstad,1 Kristian Laake,1 Sissel Åkra,1 Harald Arnesen,1,2 Svein Solheim,1,3 Ingebjørg Seljeflot1– 3 1Center for Clinical Heart Research, Department of Cardiology, Oslo University Hospital Ullevål, Oslo, Norway; 2Faculty of Medicine, University of Oslo, Oslo, Norway; 3Department of Cardiology, Oslo University Hospital Ullevål, Oslo, NorwayCorrespondence: Susanne Kristine Aune, Center for Clinical Heart Research, Oslo University Hospital (OUH) Ullevål, Pb 4956 Nydalen, Oslo, 0424, Norway, Tel +47 97002836, Email susaun@ous-hf.nob; susannekristineaune@gmail.comBackground: Recent studies suggest gut-derived lipopolysaccharide (LPS)-translocation to play a role in both systemic inflammation and in inflammatory adipose tissue. We aimed to investigate whether circulating LPS-related inflammatory markers and corresponding genetic expression in adipose tissue were associated with obesity, cardiometabolic risk factors, and dietary habits in patients with coronary artery disease.Methods: Patients (n=382) suffering a myocardial infarction 2– 8 weeks prior to inclusion were enrolled in this cross-sectional study. Subcutaneous adipose tissue (SAT), taken from the gluteal region, and fasting blood samples were collected at inclusion for determination of genetic expression of LPS-binding protein (LBP), CD14, toll-like receptor 2 (TLR2), and TLR4 in SAT, and LPS, LBP, and soluble cluster of differentiation 14 (sCD14) in the circulation. All patients filled out a dietary registration form.Results: Patients (median age 74 years, 25% women), had a median body mass index (BMI) of 25.9 kg/m2. Circulating levels of LBP correlated to BMI (p=0.02), were significantly higher in overweight or obese (BMI≥ 25 kg/m2) compared to normal- or underweight patients (BMI< 25 kg/m2), and were significantly elevated in patients with T2DM, hypertension, and MetS, compared to patients without (p≤ 0.04, all). In SAT, gene expression of CD14 and LBP correlated significantly to BMI (p≤ 0.001, both), and CD14 and TLR2 expressions were significantly higher in patients with T2DM and MetS compared to patients without (p≤ 0.001, both). Circulating and genetically expressed CD14 associated with use of n-3 PUFAs (p=0.008 and p=0.003, respectively). No other significant associations were found between the measured markers and dietary habits.Conclusion: In patients with established CAD, circulating levels of LBP and gene expression of CD14 and TLR2 in SAT were related to obesity, MetS, T2DM, and hypertension. This suggests that the LPS–LBP–CD14 inflammatory axis is activated in the chronic low-grade inflammation associated with cardiometabolic abnormalities, whereas no significant associations with dietary habits were observed.Keywords: endotoxemia, lipopolysaccharide, LPS-binding protein, gut leakage, obesity, metabolic syndrome, coronary artery disease

Objective: To study the safety and efficacy of the cholinesterase inhibitor donepezil in patients with Parkinson's disease (PD) and cognitive impairment. Methods: This was a double blind, randomised and placebo [...]

Introduction The Barthel index, initially constructed for the evaluation of patients with neuromuscular and musculoskeletal disorders [1], is recommended for the assessment of geriatric patients [2]. The instrument is useful [...]

Background. A previous study using the State-Trait Anxiety Inventory (STAI) has documented a very high prevalence of anxiety symptoms among older inpatients. The STAI produced two main concepts on factor analysis -'Nervousness' and 'Well-being'- and high scores on both caused the high overall score in these patients.Aim. To investigate how the scorings on the STAI evolve after discharge in older patients in order to understand better the reasons for their high scorings while in hospital.Methods. Sixty-three patients who had been scored on the STAI during their stay in an elder care department were followed up at 1-3 and 12 months after discharge. Data were analysed by ancova for unbalanced designs.Results. The mean STAI sum score increased significantly (3.5 points adjusted for the baseline scoring, age and gender, P < 0.001) from the first follow-up while in hospital to 1-3 months after discharge, with no significant change between the second and the last follow-up. This increase resulted primarily from a significant worsening of the score on 'well-being'. The score on 'nervousness' remained unchanged. Age did not influence the scores, while females scored higher. No interaction effects were observed, indicating that the evolvement of nervousness and anxiety after discharge is independent of gender and age. Item analysis showed that the worsening of the score on 'well-being' in these patients during the first 1-3 months after discharge was primarily caused by a lower score on the item 'I feel secure'.Conclusion. The study does not support the hypothesis that a high level of nervousness and lack of well-being among hospitalized older patients results from acute illness and hospitalization. The worsening in the score on well-being after discharge of such patients is primarily caused by low levels of feelings of security. This represents a challenge to nurses providing home-based care. [ABSTRACT FROM AUTHOR]

We have examined concurrent and prospective validity of an index of self-reported walking (RW) of 307 home-dwelling women aged 75 years and above, of whom 155 in 1 year had in all 308 falls of which 13% resulting in fractures. It consists of five items concerning various aspects of self-reported walking identified by factor analysis. The sum score on this 'RW-index' correlated moderately (r = 0.32-0.62) with a number of clinical tests of balance. With force plate measures of balance, the highest correlations were with the length of the path of centre of pressure (COP) in the frontal (r = 0.26, 95% confidence interval (CI) = 0.19-0.33) and in the sagittal plane (r = 0.24, 95% CI = 0.14-0.34). The COP measures, which were taken under dual task conditions, also had rather low correlations with the clinical tests of balance and walking, the highest one being 0.27, between tandem stance and the length of the COP path in the frontal plane. To have a poorer score on the RW-index predicted more falls (odds ratio (OR) = 1.83, p = 0.03), and fall related fractures (OR = 1.83, p = 0.03) during a 1-year follow-up. The results show that easily collected clinical information provided by older people regarding walking and balance contributes in identifying subjects at increased risk of falling and fall-related fractures. [ABSTRACT FROM AUTHOR]

High frequencies of loss of heterozygosity (LOH) in chromosome 11q22-qter have been observed in various malignancies, including breast cancer. Previous studies on breast carcinomas by Winqvist et al (Cancer Res 55: 2660-2664) have indicated that a survival factor gene is located in band 11q23, and that the highly informative microsatellite polymorphism at the APOC3 locus would be a suitable tool to perform more extensive LOH studies. In this European multicentre study, we have examined the occurrence of APOC3 LOH and evaluated the effect of LOH of this chromosomal subregion on the clinical behaviour of the disease in a cohort of 766 breast cancer patients in more detail. LOH for APOC3 was found in 42% of the studied tumours, but it was not found to be significantly associated with any of the studied clinical variables, including cancer-specific survival time or survival time after recurrent/metastatic disease. According to the present findings, the putative survival factor gene on 11q23 is not located close enough to the APOC3 gene, but apparently at a more proximal location. [ABSTRACT FROM AUTHOR]

Purpose: To identify predictors of outcome after 12 months in elderly stroke patients rehabilitated in a geriatric ward. Design: Prospective with evaluation in the subacute phase and after 12 months. Setting: Geriatric ward and outpatient clinic. Subjects: All stroke patients admitted from the acute unit to a geriatric ward for rehabilitation during a 16-month period (n =171). Main outcome measures: Place of living, mortality and social functioning (Frenchay Activities Index) 12 months following stroke. Results: Age, urinary incontinence and cognitive function were significantly associated with place of living (home versus nursing home) 12 months post stroke in bivariate analyses. However, using multivariate logistic regression analyses, only age (p = 0.005) and urinary incontinence at baseline (p = 0.028) remained independent predictors of place of living. Mortality during the first year was significantly predicted by urinary incontinence and gender (men doing worse), whereas the Barthel Activities of Daily Living (ADL) Index sumscore was the only significant independent predictor of social activities. Conclusion: Urinary incontinence at baseline seems to be a most important predictor of outcome 12 months post stroke in geriatric patients. However, with regard to social activities (Frenchay Activities Index), functional impairment in the initial phase as reflected by the Barthel ADL Index supersedes other predictors. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To identify stressors and their correlates in spouses of patients with mild dementia. DESIGN: Retrospective study of patient records. SETTING: Patients attending a Memory Clinic at Ullevaal Hospital in Oslo. SUBJECTS: 92 mildly demented patients living at home (mean age 75.7 years, 51% women, mean MMSE score 22.3) and their spouses. MAIN OUTCOME MEASURES: Frequency and types of stress suffered by spouses using validated and factor-analyzed instruments as measures. RESULTS: Twenty-five per cent or more of the spouses reported often/always having problems with the following: being depressed by the situation, having difficulties getting away on holiday, social life being affected, household routines being upset, and sleep being interrupted. Factor analysis of the Greene Caregiver Stress Scale (15 items) identified two factors; 'Social stress' and 'Depressive stress'. Social stress was associated with the patient's I-ADL level, and depressive stress with mood and behaviour of the patient. The depressive symptomatology of the patient as expressed by the spouses was related to both depressive and social stress, whereas cognitive function, as measured by the MMSE, was not an independent predictor of carer strain. CONCLUSION: Even in mildly demented patients, symptoms of carer stress are frequent. Supportive strategies such as early diagnosis, information for carers and intervention strategies are discussed. [ABSTRACT FROM AUTHOR]