Traffic-related air pollution and cognitive function in a cohort of older men

Background

Traffic-related particles induce oxidative stress and may exert adverse effects on central nervous system function, which could manifest as cognitive impairment.

Objective

We assessed the association between black carbon (BC), a marker of traffic-related air pollution, and cognition in older men.

Methods

A total of 680 men (mean ± SD, 71 ± 7 years of age) from the U.S. Department of Veterans Affairs Normative Aging Study completed a battery of seven cognitive tests at least once between 1996 and 2007. We assessed long-term exposure to traffic-related air pollution using a validated spatiotemporal land-use regression model for BC.

Results

The association between BC and cognition was nonlinear, and we log-transformed BC estimates for all analyses [ln(BC)]. In a multivariable-adjusted model, for each doubling in BC on the natural scale, the odds of having a Mini-Mental State Examination (MMSE) score ≤ 25 was 1.3 times higher [95% confidence interval (CI), 1.1 to 1.6]. In a multivariable-adjusted model for global cognitive function, which combined scores from the remaining six tests, a doubling of BC was associated with a 0.054 SD lower test score (95% CI, −0.103 to −0.006), an effect size similar to that observed with a difference in age of 1.9 years in our data. We found no evidence of heterogeneity by cognitive test. In sensitivity analyses adjusting for past lead exposure, the association with MMSE scores was similar (odds ratio = 1.3; 95% CI, 1.1 to 1.7), but the association with global cognition was somewhat attenuated (−0.038 per doubling in BC; 95% CI, −0.089 to 0.012).

Conclusions

Ambient traffic-related air pollution was associated with decreased cognitive function in older men.     

Simple nutritional intervention in patients with advanced cancers of the gastrointestinal tract,non‐small cell lung cancers or mesothelioma and weight loss receiving chemotherapy: a randomised controlled trial

Background: Weight loss in patients with cancer is common and associated with a poorer survival and quality of life. Benefits from nutritional interventions are unclear. The present study assessed the effect of dietary advice and/or oral nutritional supplements on survival, nutritional endpoints and quality of life in patients with weight loss receiving palliative chemotherapy for gastrointestinal and non‐small cell lung cancers or mesothelioma. Methods: Participants were randomly assigned to receive no intervention, dietary advice, a nutritional supplement or dietary advice plus supplement before the start of chemotherapy. Patients were followed for 1 year. Survival, nutritional status and quality of life were assessed. Results: In total, 256 men and 102 women (median age, 66 years; range 24–88 years) with gastrointestinal (n = 277) and lung (n = 81) cancers were recruited. Median (range) follow‐up was 6 (0–49) months. One‐year survival was 38.6% (95% confidence interval 33.3–43.9). No differences in survival, weight or quality of life between groups were seen. Patients surviving beyond 26 weeks experienced significant weight gain from baseline to 12 weeks, although this was independent of nutritional intervention. Conclusions: Simple nutritional interventions did not improve clinical or nutritional outcomes or quality of life. Weight gain predicted a longer survival but occurred independently of nutritional intervention.     

Development and validation of a measure of pediatric oral health-related quality of life: the POQL

Objective: To develop a brief measure of oral health‐related quality of life (OHQL) in children and demonstrate its reliability and validity in a diverse population. Methods: We administered the initial 20‐item Pediatric Oral Health‐Related Quality of Life (POQL) to children (Child Self‐Report) and parents (Parent Report on Child) from diverse populations in both school‐based and clinic‐based settings. Clinical oral health status was measured on a subset of children. We used factor analysis to determine the underlying scales and then reduced the measure to 10 items based on several considerations. Multitrait analysis on the resulting 10‐item POQL was used to reaffirm the discrimination of scales and assess the measure's internal consistency and interscale correlations. We established discriminant and convergent validity with clinical status, perceived oral health and responses on the PedsQL, and determined sensitivity to change with children undergoing ECC surgical repair. Results: Factor analysis returned a four‐scale solution for the initial items – Physical Functioning, Role Functioning, Social Functioning, and Emotional Functioning. The reduced items represented the same four scales – two each on Physical and Role and three each on Social and Emotional. Good reliability and validity were shown for the POQL as a whole and for each of the scales. Conclusions: The POQL is a valid and reliable measure of OHQL for use in preschool and school‐aged children, with high utility for both clinical assessments and large‐scale population studies.     

Extubation of the difficult airway

Managing the airway in the intensive care unit (ICU) is complicated by a wide array of physiologic factors. Difficult airway may be a consequence of patient’s anatomy or airway edema developed during the ICU stay and mechanical ventilation. The incidence of failed airways and of cardiac arrest related to airway instrumentation in the ICU is much higher than that of elective intubations performed in the operating room. In this article, we will provide a framework for identifying a difficult airway, criteria for safe extubation, as well as review the devices that are available for airway management in the ICU. Proficiency in identifying a potentially difficult airway and thorough familiarity with strategies and techniques of securing the airway are necessary for safe practice of critical care medicine     

Effects of Health Status on Word Finding in Aging

OBJECTIVES: To evaluate effects of health status on word‐finding difficulty in aging, adjusting for the known contributors of education, sex, and ethnicity. DESIGN: Cross‐sectional. SETTING: Community. PARTICIPANTS: Two hundred eighty‐four adults aged 55 to 85 (48.6% female) participating in an ongoing longitudinal study of language in aging. MEASUREMENTS: Medical, neurological, and laboratory evaluations to determine health status and presence or absence of hypertension and diabetes mellitus. Lexical retrieval evaluated with the Boston Naming Test (BNT) and Action Naming Test. RESULTS: Unadjusted regression models showed that presence of diabetes mellitus was not related to naming. Presence of hypertension was associated with significantly lower accuracy on both tasks (P<.02). Adjustment for demographics attenuated the effect of hypertension (P<.08). For the BNT, a variable combining presence, treatment, and control of hypertension was marginally significant (P<.10), with subjects with uncontrolled hypertension being least accurate (91.4%). Previously observed findings regarding the effects of age, education, sex, and ethnicity were confirmed. CONCLUSION: In this sample of older adults, hypertension contributed to the word‐finding difficulty of normal aging, but diabetes mellitus did not.     

Long-term follow-up of patients treated with neoadjuvant chemotherapy and radiotherapy for large, extremity soft tissue sarcomas

BACKGROUND:

Patients with large, high‐grade, extremity soft tissue sarcomas (STS) are at significant risk for distant recurrence and death. A regimen of preoperative chemotherapy consisting of mesna, Adriamycin (doxorubicin), ifosfamide, and dacarbazine (MAID), interdigitated with radiotherapy (RT) and followed by resection and postoperative chemotherapy with or without RT, has demonstrated high rates of local and distant control. We report the long‐term follow‐up data on 48 patients treated with this regimen compared to an historical matched‐control patient population.

METHODS:

Adult patients with high‐grade extremity STS ≥ 8 cm were treated with 3 cycles of preoperative chemotherapy combined with 44 Gy of RT followed by surgery. Three cycles of postoperative MAID were planned. For patients with positive surgical margins, 16 Gy of RT was delivered postoperatively.

RESULTS:

Patients received the MAID/RT regimen from 1989 through 1999. After a median follow‐up of 9.3 years in surviving patients in the MAID group and 13.2 years in surviving patients in the control group, the 7‐year disease‐specific and overall survival rates were 81% and 50% (P = .004) and 79% and 45% (P = .003) for the MAID and control patients, respectively. Five of 11 patients in the MAID group and 7 of 25 control patients died of sarcoma ≥5 years after treatment. One patient in the MAID group developed a fatal myelodysplasia at 53 months.

CONCLUSIONS:

For patients with high‐risk, extremity STS, the significant survival benefits conferred by an intense regimen of neoadjuvant chemoradiotherapy and surgery are sustained even with long‐term follow‐up. Cancer 2012. © 2011 American Cancer Society.     

Pulmonary toxicities of tyrosine kinase inhibitors

The incidence of pulmonary toxicities with the use of tyrosine kinase inhibitors (TKIs) is not very high; however, various case reports and studies continue to show significant variability in the incidence of these adverse events, ranging from 0.2% to 10.9%. Gefitinib and erlotinib are orally active, small-molecule inhibitors of the epidermal growth factor receptor tyrosine kinase that are mainly used to treat non-small cell lung cancer. Imatinib is an inhibitor of BCR-ABL tyrosine kinase that is used to treat various leukemias, gastrointestinal stromal tumors, and other cancers. In this article, we review data to identify the very rare but fatal pulmonary toxicities (mostly interstitial lung disease) caused by these drugs.