Atherosclerosis in the elderly:a heavy burden to bear

The World Health Organization estimates there are over thirty-two million major atherothrombotic events occur worldwide each year with nearly seventeen million directly attributable deaths. Atherothrombosis as the name refers to blood clot formation within an arterial vessel. It may occur de novo, usually over an atherosclerotic segment of the vessel, or embolised from a proximal     

How to guide therapeutic decisions in a patient-tailored approach to treatment of IBD?

Therapeutic decisions in the treatment of IBD involve the initial choice of therapy(ies) and designing a long-term strategy for the individual patient. Putting forward clear therapeutic aims is therefore critical in order to assess treatment success and to guide the sequential use of therapies. Although the ultimate goal of therapy is to achieve steroid-free remission and avoid complications and surgeries, the first therapeutic intervention will achieve these aims only in a minority of patients. Depending on the requirements and successes of each stage of therapy, interim goals are pursued which may be small steps towards the total control of the disease. A patient-tailored approach does not necessarily conflict with algorithm-based decision-making; indeed, they are complementary. The former allows the skipping of some steps in the algorithm, based on the individual patient characteristics. The latter supplies a basis for the rational sequential use of drugs. Many physicians use an accelerated step-up approach in the treatment of IBD, although it has not yet been established whether this is associated with a better outcome. Whether or not an endoscopic or (and) CT or MRI assessment is conducted, the therapeutic approach should be based on mucosal activity and the location and extent of the disease. Treatments that do not heal (or at least improve) ulcers are not to be continued if they have been given a reasonable time to work. Biomarkers like C-reactive protein and calprotectin can be useful surrogates in this setting.     

Immunosuppression without immunosuppression? How to be a tolerant individual in a dangerous world

The field of transplantation has developed based on two principles: allografts are rejected because they express foreign antigens, and the immune system must be suppressed to prevent rejection. Recently, in vitro and in vivo experimental evidence has accumulated that calls both of these beliefs into question. This article reviews an alternative approach to transplantation that focuses on tissue injury as the instigator of graft rejection and employs physiological mechanisms of tolerance to avoid graft loss. Methods that allow for defense against infectious microbes while at the same time allowing for graft survival are proposed. In particular, the rationale behind the use of anti-CD154 antibody treatment is highlighted. A model is introduced that takes into consideration the experimental successes seen with anti-CD154 therapies ^{1 1} Editor's comment: Infection and cancer are the main complications of the long-term immunosuppression currently used to prevent allograft rejection. Strategies aimed at the induction of tolerance have as a central goal the preservation of the host's antimicrobial responses with the loss of immune reactivity to transplanted tissue antigens. Dr. Kirk takes up this challenge by summarizing the theoretical arguments favoring a strategy based on costimulatory blockade aimed at CD154 (CD40-ligand) in the absence of nonspecific immune suppression. Thus far, the absence of opportunistic infection is a striking feature of primates with long-term allograft survival. This approach provides an important new theme in basic transplantation research. Jay A. Fishman, M.D.
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Is there a benefit to adding rituximab to CHOP in the overall survival of patients with B-cell non-Hodgkin's lymphoma in a developing country?

Rituximab (R) has changed the prognosis of patients with non-Hodgkin's lymphoma (NHL) in developed countries, but its role has not been analyzed in underprivileged circumstances. One hundred and two patients with NHL treated in a developing country were analyzed: 28 patients with follicular lymphoma (FL) and 74 with diffuse large B-cell lymphoma (DLCL). Patients were treated upfront with either cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) or R-CHOP; the decision to employ R depending solely on the ability of patients to defray it. In DLCL, 42 were given CHOP and 32 R-CHOP, whereas in FL, 19 were given CHOP and 9 R-CHOP. The impact of the addition of R was found to be clearer in FL than in DLCL. In patients with DLCL, the overall survival (OS) was 87% at 80 months for those treated with R-CHOP and 84% at 145 months for those treated with CHOP (not significant). In patients with FL, the OS was 89% at 88 months for those treated with R-CHOP and 71% at 92 months for those treated with CHOP (P = 0··05). In a multivariate analysis, other variables which were identified to be associated with the OS were IPI and number of cycles in DLCL. It is concluded that R produced a mild positive impact in the OS of patients with FL, but not in those with DLCL. Since the addition of R results in a 36-fold increase in treatment costs, these observations may be important to decide therapeutic approaches in NHL patients living in underprivileged circumstances.     

Interested in developing a national programme to reduce dietary salt?

High dietary salt is a major contributor to increased blood pressure, the leading risk for death worldwide. In several countries, national programmes to reduce dietary salt have been implemented with leadership and involvement of hypertension experts. Other hypertension experts may be interested in assisting or leading a national programme to reduce dietary salt, however, may not have the experience or training to do so. The article is based on the experiences of three hypertension experts who have led the development of national dietary salt reduction programmes in the United Kingdom, Australia and Canada. The article advises developing leadership and a coalition, conducting a nation-specific environmental scan of facilitators and barriers, estimating the national health and financial costs of high dietary salt and the benefits of reducing salt intake, obtaining core documents to provide the scientific rational for the programme, developing a policy statement to outline the required actions to be undertaken, engaging government and industry, using media to gain public support, overcoming industry supported opposition and sustaining the effort long term. Resources and potential sources for international collaboration are provided as well as caveats for developing the programme within the specific nations' context and overall effort to improve health. Developing and leading a national salt reduction programme is a major commitment, however, reducing dietary salt is estimated to be one of the most effective strategies to improve a nation's health.     

Advanced imaging to predict response to chemotherapy in colorectal liver metastases – a systematic review

Background

The assessment of colorectal liver metastases (CRLM) after treatment with chemotherapy is challenging due to morphological and/or functional change without changes in size. The aim of this review was to assess the value of FDG-PET, FDG-PET-CT, CT and MRI in predicting response to chemotherapy in CRLM.

How to establish a first-class international scientific journal in China？

INTRODUCTION In 2005, China Ministry of Science and Technology organized and implemented a research project on “Howto establish a first-class international scientific journal in China”. This issue is indeed an important but difficult topic that deserves…     

Anaemia in diabetes: is there a rationale to TREAT?

Background Anaemia is a common finding in patients with diabetes, particularly in those with overt nephropathy or renal impairment. In tertiary clinics, at least one outpatient in five with diabetes has anaemia, for whom it constitutes a significant additional burden.Discussion Anaemia is associated with an increased risk of diabetic complications including nephropathy, retinopathy and macrovascular disease. Anaemia may also be significant in determining the outcome of heart failure and hypoxia-induced organ damage in diabetes. While several factors contribute to the increased prevalence of anaemia in diabetes, the failure of the kidney to increase erythropoietin in response to falling haemoglobin appears to be the dominant factor. Although there is a clear rationale for correcting anaemia in people with diabetes, it remains to be established whether this will lead to improved outcomes. Moreover, the balance of risks, costs, and benefits remains to be established in patients with diabetes. The Trial to Reduce Cardiovascular Events with Aranesp (darbepoetin alpha) Therapy (TREAT) is a randomised controlled trial designed to determine the impact of anaemia correction on mortality and non-fatal cardiovascular events in patients with type 2 diabetes and stage 3–4 nephropathy.Conclusion It is anticipated that TREAT will help to define the optimal approach to the management of anaemia in diabetes.     

MRSA in nursing homes in the Netherlands 1989 to 1998: a developing reservoir?

The prevalence of methicillin resistant Staphylococcus aureus (MRSA) in Dutch nursing homes in 1998 was higher than that found in 1989 to 1997. The increased prevalence of MRSA could lead to colonisation outside these nursing homes. A study of the prevale     

Promoting Careers in Gerontology to Students: What Are Undergraduates Seeking in a Career?

The graying of the Baby Boomers has created a shortage of professionals in aging-related careers. However, colleges and universities with gerontology and aging programs face a challenge of recruiting students. The purpose of this study was to determine what students are looking for in a career and whether these attributes are congruent with careers in gerontology. Results of this study indicated that factors important to students in a future career include whether career is enjoyable, has adequate benefits, provides personal fulfillment, provides excitements, provides an opportunity to help others, is well respected by others, and provides opportunities for employment.