Duration of survival in senile dementia

In this study 297 institutionalized patients with primary degenerative dementia were investigated. Age at onset of dementia was determined and individual longevity quotients (i.e. actual duration of survival divided by expected survival) were calculated. Expected survival was derived from the Dutch life tables for the general population. Age at onset of dementia was 75.6 +/- 7.8 years (mean +/- SD). Duration of dementia until death was 7.2 +/- 4.1 years. Dementia of early onset (before age 76) was associated with a significantly reduced life expectancy (LQ = 0.70 +/- 0.30), but this was not found for onset after age 75 (LQ = 0.91 +/- 0.58). Duration of symptoms at the time of admission into a nursing home was not associated with severity of behavioural and cognitive impairments as measured with behaviour rating scales. However, the severity of behavioural impairments predicted 1-year survival after admission, as could be shown by multivariate analysis which corrected for the effects of age and sex.     

Multimodal Guided Self-Help Exercise Program to Prevent Speech,Swallowing, and Shoulder Problems Among Head and Neck Cancer Patients: A Feasibility Study

Background

During a 6-week course of (chemo)radiation many head and neck cancer patients have to endure radiotherapy-induced toxicity, negatively affecting patients’ quality of life. Pretreatment counseling combined with self-help exercises could be provided to inform patients and possibly prevent them from having speech, swallowing, and shoulder problems during and after treatment.

Objective

Our goal was to investigate the feasibility of a multimodal guided self-help exercise program entitled Head Matters during (chemo)radiation in head and neck cancer patients.

Methods

Head and neck cancer patients treated with primary (chemo)radiation or after surgery were asked to perform Head Matters at home. This prophylactic exercise program, offered in three different formats, aims to reduce the risk of developing speech, swallowing, shoulder problems, and a stiff neck. Weekly coaching was provided by a speech and swallowing therapist. Patients filled out a diary to keep track of their exercise activity. To gain insight into possible barriers and facilitators to exercise adherence, reports of weekly coaching sessions were analyzed by 2 coders independently.

Results

Of 41 eligible patients, 34 patients were willing to participate (83% uptake). Of participating patients, 21 patients completed the program (64% adherence rate). The majority of participants (58%) had a moderate to high level of exercise performance. Exercise performance level was not significantly associated with age (P=.50), gender (P=.42), tumor subsite (P=1.00) or tumor stage (P=.20), treatment modality (P=.72), or Head Matters format (Web-based or paper) (P=1.00). Based on patients’ diaries and weekly coaching sessions, patients’ perceived barriers to exercise were a decreased physical condition, treatment-related barriers, emotional problems, lack of motivation, social barriers, and technical problems. Patients’ perceived facilitators included an increased physical condition, feeling motivated, and social and technical facilitators.

Conclusions

Head Matters, a multimodal guided self-help exercise program is feasible for head and neck cancer patients undergoing (chemo)radiation. Several barriers (decreased physical condition, treatment-related barriers) and facilitators (increased physical condition, feeling motivated) were identified providing directions for future studies. The next step is conducting a study investigating the (cost-)effectiveness of Head Matters on speech, swallowing, shoulder function, and quality of life.     

A four-hour infusion of recombinant hirudin results in long-term inhibition of arterial-type thrombosis in baboons

Intravenous recombinant (r)-hirudin has a potent antithrombotic effect in aspirin- and heparin-resistant platelet-dependent thrombus formation in baboon models. However, these thrombi reform when therapy is stopped after 60 minutes. To determine if 4 hours of therapy can produce a lasting antithrombotic effect, we investigated the extent of deposition of 111In-labeled platelets onto 0.5-cm2 segments of Dacron vascular grafts for 53 hours. These grafts had been incorporated into exteriorized permanent femoral arteriovenous shunts in baboons. Platelet deposition in eight untreated animals was generally sigmoidal. Maximum platelet deposition, 1.7% +/- 0.9% of injected labeled platelets, was reached after approximately 4 hours. Deposition then gradually decreased to 0.4% +/- 0.2% of injected labeled platelets after 53 hours. After a thrombus was allowed to form for 15 minutes in six animals, intravenous treatment with r-hirudin at a dose of 20 nmol (0.14 mg)/kg-min-1 (aPTT > 300 seconds) was started and maintained for 4 hours. Platelet deposition was interrupted during treatment. After infusion was stopped, platelets accumulated again, but not as much as in the untreated animals. Maximum platelet deposition, 0.7% +/- 0.2% of injected labeled platelets, was significantly less (P < .01), and was reached after approximately 23 hours. Thereafter, deposition decreased to 0.4% +/- 0.2% at 53 hours. The shunts in all of the untreated animals occluded at some stage during the study, while only one shunt occluded in the treated animals.(ABSTRACT TRUNCATED AT 250 WORDS)     

Fluid status monitoring with a wireless network to reduce cardiovascular-related hospitalizations and mortality in heart failure: rationale and design of the OptiLink HF Study (Optimization of Heart Failure Management using OptiVol Fluid Status Monitoring and CareLink)

AIMS: The Optimization of Heart Failure Management using OptiVol Fluid Status Monitoring and CareLink (OptiLink HF) study is designed to investigate whether OptiVol fluid status monitoring with an automatically generated wireless CareAlert notification via the CareLink Network can reduce all-cause death and cardiovascular hospitalizations in an HF population, compared with standard clinical assessment. Methods Patients with newly implanted or replacement cardioverter-defibrillator devices with or without cardiac resynchronization therapy, who have chronic HF in New York Heart Association class II or III and a left ventricular ejection fraction ≤35% will be eligible to participate. Following device implantation, patients are randomized to either OptiVol fluid status monitoring through CareAlert notification or regular care (OptiLink 'on' vs. 'off'). The primary endpoint is a composite of all-cause death or cardiovascular hospitalization. It is estimated that 1000 patients will be required to demonstrate superiority of the intervention group to reduce the primary outcome by 30% with 80% power. CONCLUSION: The OptiLink HF study is designed to investigate whether early detection of congestion reduces mortality and cardiovascular hospitalization in patients with chronic HF. The study is expected to close recruitment in September 2012 and to report first results in May 2014.     

Subjects with hip osteoarthritis show distinctive patterns of trunk movements during gait-a body-fixed-sensor based analysis

Background  

Compensatory trunk movements during gait, such as a Duchenne limp, are observed frequently in subjects with osteoarthritis of the hip, yet angular trunk movements are seldom included in clinical gait assessments. Hence, the objective of this study was to quantify compensatory trunk movements during gait in subjects with hip osteoarthritis, outside a gait laboratory, using a body-fixed-sensor based gait analysis. Frontal plane angular movements of the pelvis and thorax and spatiotemporal parameters of persons who showed a Duchenne limp during gait were compared to healthy subjects and persons without a Duchenne limp.     

Non-N-methyl-d-aspartate glutamate receptors in the lateral hypothalamus modulate cardiac baroreflex responses in conscious rats

• 1 In the present study, we investigated the effects of inhibition of the lateral hypothalamus (LH) neurotransmission with bilateral microinjection of CoCl₂, a non‐selective blocker of neurotransmission, on modulation of cardiac baroreflex responses in conscious rats as well as the involvement of LH glutamatergic neurotransmission in this modulation.
• 2 Reflex bradycardiac and tachycardiac responses to blood pressure increases (following i.v. infusion of phenylephrine) or decreases (following i.v. infusion of sodium nitroprusside) were investigated in conscious male Wistar rats. Responses were evaluated before and after microinjection of 1 nmol/100 nL CoCl₂, 2 nmol/100 nL 1,2,3,4‐tetrahydro‐6‐nitro‐2,3‐dioxobenzoquinoxaline‐7‐sulphonamide (NBQX; a selective non‐N‐methyl‐d ‐aspartate (NMDA) glutamate receptor antagonist) or different doses (2, 4 or 8 nmol/100 nL) of the selective NMDA glutamate receptor antagonist LY235959.
• 3 Microinjection of CoCl₂ into the LH had no effect on the tachycardiac baroreflex response, but did evoke a decrease in the reflex bradycardia caused by increases in blood pressure. Microinjection of NBQX into the LH had a similar effect on reflex bradycardia as CoCl₂, but had no effect on the tachycardiac response. Microinjection of increasing doses of LY235959 into the LH had no effect on the cardiac baroreflex response.
• 4 In conclusion, the data suggest that the LH has a tonic facilitatory influence on the parasympathetic component of the baroreflex. The results also indicate that this facilitatory influence is mediated by local LH glutamatergic neurotransmission through non‐NMDA glutamatergic receptors.

     

The graduate entry generation: a qualitative study exploring the factors influencing the career expectations and aspirations of a graduating cohort of graduate entry dental students in one London institution

Background

Dentistry in the UK has a number of new graduate-entry programmes. The aim of the study was to explore the motivation, career expectations and experiences of final year students who chose to pursue a dental career through the graduate entry programme route in one institution; and to explore if, and how, their intended career expectations and aspirations were informed by this choice.

Method

In-depth interviews of 14 graduate entry students in their final year of study. Data were transcribed verbatim and analysed using framework analysis.

Results

There were three categories of factors influencing students' choice to study dentistry through graduate entry: 'push', 'pull' and 'mediating'. Mediating factors related to students' personal concerns and circumstances, whereas push and pull factors related to features of their previous and future careers and wider social factors. Routes to Graduate Entry study comprised: 'early career changers', 'established career changers' and those pursuing 'routes to specialisation'. These routes also influenced the students' practice of dentistry, as students integrated skills in their dental studies, and encountered new challenges. Factors which students believed would influence their future careers included: vocational training; opportunities for specialisation or developing special interests and policy-related issues, together with wider professional and social concerns. The graduate entry programme was considered 'hard work' but a quick route to a professional career which had much to offer. Students' felt more could have been made of their pre-dental studies and/or experience during the programme. Factors perceived as influencing students' future contribution to dentistry included personal and social influences. Overall there was strong support for the values of the NHS and 'giving back' to the system in their future career.

Conclusion

Graduate entry students appear to be motivated to enter dentistry by a range of factors which suit their preferences and circumstances. They generally embrace the programme enthusiastically and seek to serve within healthcare, largely in the public sector. These students, who carry wider responsibilities, bring knowledge, skills and experience to dentistry which could be harnessed further during the programme. The findings suggest that graduate entry students, facilitated by varied career options, will contribute to an engaged workforce.     

冠状动脉粥样硬化性心脏病患者红细胞流变性特征在红花注射液干预后的表现

目的:经红花注射液干预后,观察冠状动脉粥样性心脏病患者红细胞电泳指标及红细胞变形性的变化。方法:①选取2001-02/2002-10河北北方学院附属第一医院心内科住院的冠状动脉粥样硬化性心脏病患者50例作为冠状动脉粥样硬化性心脏病组,男31例,女19例,平均年龄(43.9±5.6)岁,对本实验知情同意,均自愿参加。②纳入标准:经心电图、超声心动图证实有典型心绞痛、心绞痛不典型或陈旧性心肌梗死史,由专科医师确诊冠脉造影狭窄率≥50%;治疗前均未进行降脂、利尿剂、促血尿酸排泄药、阿司匹林及肝素(包括低分子肝素钠)治疗;无肝肾疾病、内分泌系统疾病。③以30例自愿体检受试的健康学生及医务人员作为正常对照组,男女各15例,平均年龄(35.4±7.4)岁。两组间年龄、性别差异无显著性意义。④“得强”红花注射液,主要成分为红花黄色素,由太原华卫药业有限公司生产,批号010302。⑤冠状动脉粥样硬化性心脏病组取红花注射液6.0～8.0mL,溶于500mL葡萄糖注射液中,静点,1次/d,15d为1个疗程,共1个疗程。正常对照组未给予任何干预措施。⑥治疗前后两组空腹抽取肘静脉血5mL,应用红细胞变形分析仪检测红细胞电泳指标及红细胞变形性的变化。结果:50例冠状动脉粥样硬化性心脏病患者均进入结果分析。①治疗前后红细胞电泳指标的变化:与正常对照组比较,冠状动脉粥样硬化性心脏病组治疗前红细胞电泳时间显著延长,红细胞电泳长度与红细胞迁移率显著降低(t=3.198～6.963,P均<0.01);治疗后红细胞电泳时间缩短,红细胞电泳长度与红细胞迁移率增加(t=2.212～3.672,P<0.05或0.01),但仍与正常对照组存在显著性差异(t=1.700～4.792,P<0.05或0.01)。②治疗前后不同切变率下红细胞变形性变化:与正常对照组比较,冠状动脉粥样硬化性心脏病组治疗前在300S-1,230S-1,115S-1切变率下的红细胞变形性均显著降低(t=1.956～2.459,P<0.05或0.01);治疗后各切变率下的红细胞变形性均显著增强(t=3.162～4.187,P均<0.01),且在230S-1、115S-1切变率下冠状动脉粥样硬化性心脏病组红细胞变形性显著高于正常对照组(t=2.089～2.748,P<0.05或0.01)。结论:冠状动脉粥样硬化性心脏病患者给予红花注射液后,红细胞电泳时间、电泳长度及迁移率均有所好转,且不同切变率下的红细胞变形性亦有所增强,提示红花注射液对冠状动脉粥样硬化性心脏病的干预与改善红细胞流变性异常有关。