The social sciences and successful aging: Issues for Asia–Oceania

Aim:   This paper presents social science understandings of successful aging for a broad audience in multidisciplinary gerontology in Asia–Oceania.
Methods:   The international literature on social science aspects of successful aging is reviewed with a focus on Asia and social improvement.
Results:   New positive approaches to aging research are identifying opportunities for maintaining capacities and well-being over the life course. Successful aging, productive aging, and active aging are key concepts. Increasing life expectancy and fertility control are major social achievements that underpin population aging as the mainstream social transformation facing the world. Asia will be at the forefront of this change and the consequences will vary greatly between cultures, nations, and subgroups within them. Older people generally maintain good quality of life and the capacity to 'age well' is influenced by life-long maturation and emotional, social, and economic resources. Good health can be enhanced through positive actions such as physical activity, good nutrition, and not smoking. Mental capacities can also be improved and maintained throughout old age. In advanced old age, the 'fourth age', the focus turns to ameliorating the effects of loss and to maintaining dignity.
Conclusions:   The social sciences contribute knowledge useful for improving life experiences for older people and aging societies. Population aging is central to national economic development. Public policy and individual action concerning aging can benefit all age groups. To better inform these developments it is important to address the serious shortfall of social science research on aging in the Asia–Oceania region.     

Functional MRI Studies of Animal Models in Epilepsy

Summary:  Functional magnetic resonance imaging (fMRI) has become a widely used imaging modality in the past decade in both human studies and animal models. Epilepsy presents unique challenges for neuroimaging due to subject movement during seizures, and the need to correlate the timing of often unpredictable seizure events with fMRI data acquisition. These challenges can readily be overcome in animal models of epilepsy. Animal models also provide an opportunity to investigate the fundamental relationships between fMRI signals and brain electrical activity through invasive studies not possible in humans. fMRI studies in animal models of epilepsy can enable us to correctly interpret fMRI signal increases and decreases in human studies, ultimately elucidating specific networks that will be targeted for improved treatment of epilepsy.     

Growth hormone effects on hypertrophic scar formation: a randomized controlled trial of 62 burned children

The hypercatabolism after massive pediatric burns has been effectively treated with recombinant human growth hormone, an anabolic agent that stimulates protein synthesis and abrogates growth arrest. While experimental studies have shown increased potential for fibrosis induced by growth hormone therapy, adverse effects on human scars have not been investigated. Our aim was to evaluate hypertrophic scar formation in 62 patients randomized to receive injections of 0.05 mg/kg/day of recombinant human growth hormone or placebo, from discharge until 1 year after burn. Scar scales were used to evaluate scar-severity at discharge, 6, 9, 12, and 18-24 months after burn, by three observers blinded to treatment. Computer-assisted planimetry allowed quantification of percentage of hypertrophic scar formation. Types I and III collagens were localized and quantified in scars and normal skin of patients from both groups, using immunohistochemistry with confocal laser microscopy analysis. Insulin-like growth factor-1 blood levels helped assess compliance. Statistical analysis showed that scar hypertrophy significantly increased from 6 to 12 months after injury in both groups, while decreasing at 18-24 months postburn. Types I and III collagens were statistically increased in the reticular layer of scars from both groups when compared to paired normal skin. Insulin-like growth factor-1 was significantly increased in the recombinant human growth factor-treated group. No differences were seen when recombinant human growth factor and control groups were compared using the scar scales, planimetry, or immunohistochemistry. We concluded that recombinant human growth hormone therapy did not adversely affect scar formation and should not contraindicate the administration of recombinant human growth hormone as a therapeutic approach to severely burned children.     

Treatment of dural sinus thrombosis using selective catheterization and urokinase

Thrombosis of the cerebral dural venous sinuses, cortical draining veins, and deep cerebral veins is a rare clinical finding. Because of its low incidence and multiple etiologies, the optimum therapy for this condition will only be elucidated by a multicenter, randomized prospective study. At our institution, we favor early and aggressive management of cerebral venous sinus thrombosis with transfemoral, venous intradural infusions of the fibrinolytic agent urokinase. To date, treatment of only 13 patients using this technique has been reported in the English literature. This report adds 12 more such treated patients. Despite the presence of preinfusion infarcts in 5 patients, four of which were hemorrhagic, we incurred no major therapeutic morbidity. Functional sinus patency was achieved in 11 of 12 patients, with our only true failure occurring in an individual with symptoms of at least 2 months' duration. Good to excellent clinical outcome was achieved in 10 of 11 patients (one newborn had inadequate follow-up).     

Placement of transpedicular vertebral screws close to anterior vertebral cortex. Description of methods

Strengthening of the screw-vertebra interface has been shown to occur with implantation of longer transpedicular screws, the tips of which are placed closer to the anterior cortex of the vertebral body. Such implantation probably results in increased risk for anterior cortex penetration and associated vascular or pulmonary damage. Typically recommended lateral and posterior-anterior radiography is shown here to provide potentially misleading visualization during implantation. To reduce the risk of anterior cortical penetration, presented here are 1) a radiographic method ("near approach view") that avoids this problem and allows direct visualization of the relationship between drill bit or screw tip and anterior vertebral cortex, and 2) a surgical technique ("mallet method") that provides both an audible and a palpable change when the drill bit contacts the anterior cortex.     

Lipid screening in HIV-infected veterans

BACKGROUND: Lipid screening is recommended for patients taking protease inhibitors (PIs). METHODS: We examined data from the Veterans Administration Immunology Case Registry to assess lipid screening among HIV-infected veterans who received PIs for at least 6 consecutive months during 1999 and 2001. We estimated crude and adjusted associations between lipid screening and patient characteristics (age, gender, HIV exposure, and race/ethnicity), comorbidities (AIDS, cardiovascular disease, diabetes, hypertension, smoking, and hyperlipidemia), and facility characteristics (urban location, case management, guidelines, and quality improvement programs). RESULTS: Among 4065 patients on PIs, clinicians screened 2395 (59%) for lipids within 6 months of initiating treatment. Adjusting for patient characteristics, comorbidities, facility traits, and clustering, lipid screening was more common among patients who were cared for in urban areas (relative risk [RR] = 1.3, confidence limits: 1.0-1.5), diabetic (RR = 1.2, confidence limits: 1.1-1.3), or previously hyperlipidemic (RR = 1.4, confidence limits: 1.3-1.5) and less common among patients with a history of intravenous drug use (IVDU) (RR = 0.90, confidence limits: 0.79-1.0) or unknown HIV risk (RR = 0.85, confidence limits: 0.75-0.95). CONCLUSIONS: Six in 10 patients taking PIs receive lipid screening within 6 months of PI use. Systemic interventions to improve overall HIV quality of care should also address lipid screening, particularly among patients with unknown or IVDU HIV risk and those cared for in nonurban areas.     

Frequency of Cytotoxic T Lymphocyte Precursors to Herpes Simplex Virus Type 1 as Determined by Limiting Dilution Analysis

The conditions for establishing a limiting dilution assay to measure cytotoxic T lymphocyte precursors (CTL-P) against herpes simplex virus type 1 (HSV-1) were determined. Analysis by Poisson statistics demonstrated that the estimated frequency of HSV-1-reactive cells in the spleens of normal mice was less than 1/250,000. In contrast, mice immunized previously with infectious HSV-1 demonstrated a CTL-P frequency between 1/3,500 and 1/15,670. The generation of a maximum cytotoxic T lymphocyte response required that mice be primed in vivo with infectious virus. Immunization with inactivated virus either failed to elicit detectable CTL-P frequencies or gave frequencies markedly less than those induced with infectious virus. To obtain positive cultures, the responder cell population had to be exposed to stimulator splenocytes expressing viral antigens. Normal splenocytes without virus or normal splenocytes with T cell growth factor did not result in significant cytotoxicity. Split culture analysis comparing cytotoxicity against syngeneic and allogeneic virus-infected targets provided evidence for specificity, H-2 restriction, and the T cell nature of the CTL-P. It was determined that precursors were eliminated by treatment with anti-Thy 1, Lyt 2.1, or Lyt 1.1, indicating the CTL-P were Lyt 1(+)2(+) cells. Cytotoxicity was reduced after treatment of the responders with anti-Lyt 2 plus complement, which gave further evidence of the T cell nature of the cytotoxic T lymphocytes. These experiments demonstrated the feasibility of using the limiting dilution approach as a highly sensitive and quantitative means to measure the cell-mediated immune response to HSV-1 antigens.     

Pressure and temperature: time-dependent modulation of membrane properties in a bifurcating axon

A crustacean bifurcating motor neuron that selectively controls output to its daughter branches was exposed to helium pressure of 1-200 atmospheres (atm) and temperatures of 9-22 degrees C. The membrane responses of this integrative axon were monitored by intra- and extracellular recording, macropatch clamp, and Vaseline gap voltage clamp. The response of the neuron to pressure changes was biphasic and time dependent. Initially there was an increase in action potential amplitude and rate of rise, in magnitude of the inward sodium current, in conduction velocity, and in the ability of the branch point to conduct at high frequency. After 10-20 min at a given pressure above 35 atm, these functional measures declined to levels below control. Action potential duration increased throughout. In addition, membrane resting potential was depolarized by 10-15 mV, and input resistance increased. Pressure-related depolarization was not seen in an axon pretreated with ouabain, a result consistent with pressure inhibition of the electrogenic sodium pump in this axon. Cooling induced changes opposite to the initial effects and similar to the delayed effects of pressure in all measures, including action potential amplitude, rise time, duration, membrane potential, membrane resistance, inward current amplitude, conduction velocity, and ability to conduct at high frequency. This axon differs from other axons that have been studied at hyperbaric pressure in the bimodal nature of its response and in the magnitude of pressure-related depression of membrane properties related to excitability.