Do clinical characteristics and outcome in nonagenarians with a hip fracture differ from younger patients?

Aim: To compare clinical characteristics and outcome of nonagenarian hip fracture patients with younger patients aged 65–89 years. Methods: This was a cohort follow‐up study of admissions for a hip fracture between 2005–2010 (mean follow up of 3.5 years) in two teaching hospitals in the Netherlands; 230 nonagenarians and 1014 patients aged 65–89 years were included. Clinical characteristics, adverse events, mobility and mortality were compared. Results: Nonagenarians were more likely to be female and anemic (both P < 0.001), and had more trochanteric fractures (P = 0.005). The number of American Society of Anesthesiologists III/VI classified patients did not differ between the two groups. During the hospital stay, adverse events were more frequently observed in nonagenarians compared with younger patients (P < 0.001). The length of stay was significantly longer in nonagenarians (P < 0.001), and the 90‐day readmission rate was similar. Absolute mortality was higher in nonagenarians (P < 0.001), excess mortality, however, was comparable. Before admission, 40.0% of the nonagenarians lived in their own home, and 40.9% had returned 3 months postfracture. The rate of returning to their own home was lower compared with younger patients (P < 0.001). Prefracture mobility was worse in nonagenarians compared with the younger group, but 3 months after discharge, the number of patients that regained prefracture mobility was comparable in both age groups. Conclusions: Nonagenarian hip fracture patients differ significantly from younger patients aged 65–89 years with respect to clinical characteristics and long‐term outcome. However, almost half of the nonagenarians returned to their own home and more than half regained their prefracture level of mobility. Given these findings, prevention strategies for hip fracture and adverse events during hospital stay that focus particularly on frail nonagenarians are highly recommended. Geriatr Gerontol Int 2013; 13: 190–197.     

Effects of working memory load on oscillatory power in human intracranial EEG

Studies of working memory load effects on human EEG power have indicated divergent effects in different frequency bands. Although gamma power typically increases with load, the load dependency of the lower frequency theta and alpha bands is uncertain. We obtained intracranial electroencephalography measurements from 1453 electrode sites in 14 epilepsy patients performing a Sternberg task, in order to characterize the anatomical distribution of load-related changes across the frequency spectrum. Gamma power increases occurred throughout the brain, but were most common in the occipital lobe. In the theta and alpha bands, both increases and decreases were observed, but with different anatomical distributions. Increases in theta and alpha power were most prevalent in frontal midline cortex. Decreases were most commonly observed in occipital cortex, colocalized with increases in the gamma range, but were also detected in lateral frontal and parietal regions. Spatial overlap with group functional magnetic resonance imaging results was minimal except in the precentral gyrus. These findings suggest that power in any given frequency band is not a unitary phenomenon; rather, reactivity in the same frequency band varies in different brain regions, and may relate to the engagement or inhibition of a given area in a cognitive task.     

Local spatial effect of 50 Hz cortical stimulation in humans

Purpose: Cortical stimulation to abort seizures is under human investigation. Ideal electrode placement and stimulating parameters are unknown with poor understanding of tissue volume affected by stimulation or duration and nature of its effect on cortical activity. To help characterize this effect, we analyzed electrocorticography (ECoG) recorded adjacent to stimulated contacts during and after bipolar stimulation in patients undergoing functional cortical mapping with subdural electrodes. Methods: We analyzed four functional mapping procedures in three patients. One row of contacts was chosen for bipolar stimulation at sequential distances. Stimulation parameters were those used for functional mapping. Pooled Teager energy (TE) and band power were calculated for: (1) baseline, (2) 5 s during stimulation, and (3) 5–15 s after the stimulus. Results: Average TE increased during stimulation, falling with distance from the stimulus. Average poststimulus TE increased (284–905%) compared to baseline. Increased TE was observed: (1) up to 10 s after stimulation, (2) stimulation amplitudes of 4 mA or greater, and (3) up to 2 cm from the stimulus. There was no difference in poststimulus TE between the stimulated pair of contacts and outside the pair. Greatest increase in poststimulus signal power occurred in beta and gamma bands. Conclusions: Human cortical stimulation of 50 Hz resulted in elevated ECoG energy measurements up to 10 s poststimulation. Contacts >2 cm from stimulated electrodes did not show significant response to stimulation. Separating contacts >2 cm on the cortical surface may not result in efficacious treatment of seizure activity using common stimulation amplitudes (2–10 mA).     

A carcinoid tumor associated with chylous ascites and elevated tumor markers

The case is reported of a 74-year-old woman with a carcinoid tumor associated with chylous ascites and elevated tumor markers, CEA, and CA-125. In addition, the novel use of chromogranin-A quantitative assay from peripheral blood and ascetic fluid is discussed. The patient's clinical course and beneficial response to chemotherapy is also discussed and previous similar cases reported in the English-language literature are reviewed.     

Phase space topography and the Lyapunov exponent of electrocorticograms in partial seizures

Summary Electrocorticograms (ECoG's) from 16 of 68 chronically implanted subdural electrodes, placed over the right temporal cortex in a patient with a right medial temporal focus, were analyzed using methods from nonlinear dynamics. A time series provides information about a large number of pertinent variables, which may be used to explore and characterize the system's dynamics. These variables and their evolution in time produce the phase portrait of the system. The phase spaces for each of 16 electrodes were constructed and from these the largest average Lyapunov exponents (L's), measures of chaoticity of the system (the larger the L, the more chaotic the system is), were estimated over time for every electrode before, in and after the epileptic seizure for three seizures of the same patient. The start of the seizure corresponds to a simultaneous drop in L values obtained at the electrodes nearest the focus. L values for the rest of the electrodes follow. The mean values of L for all electrodes in the postictal state are larger than the ones in the preictal state, denoting a more chaotic state postictally. The lowest values of L occur during the seizure but they are still positive denoting the presence of a chaotic attractor. Based on the procedure for the estimation of L we were able to develop a methodology for detecting prominent spikes in the ECoG. These measures (L^*) calculated over a period of time (10 minutes before to 10 minutes after the seizure outburst) revealed a remarkable coherence of the abrupt transient drops of L^* for the electrodes that showed the inital ictal onset. The L^* values for the electrodes away from the focus exhibited less abrupt transient drops. These results indicate that the largest average Lyapunov exponent L can be useful in seizure detection as well as a discriminatory factor for focus localization in multielectrode analysis.     

异丙酚复合氯胺酮全麻诱导对血流动力学的影响

0　引言　我们观察氯胺酮对异丙酚静脉复合诱导时血流动力学的影响 ,并以芬太尼复合异丙酚全麻诱导做对照研究 .1　对象和方法1.1　对象　 30例 ASA ～ 级择期行全麻手术的患者 .男2 0例 ,女 10例 ,年龄 18～ 5 5岁 ,体质量 49～ 75 kg,随机分为两组 ,A组为异丙酚复合氯胺酮组 ,B组为异丙酚复合芬太尼组 ,每组 15例 .1.2　方法　术前 30 min im苯巴比妥钠 0 .1g,阿托品 0 .5mg. A组诱导为 iv异丙酚 2 mg· kg- 1 ,氯胺酮 1mg· kg- 1及维库溴胺 0 .1mg· kg- 1 . B组为 iv异丙酚 2 m g· kg- 1 ,芬太尼 2 μg· kg- 1 及维库溴胺 0 .1mg…     

Close mapping of the focal non-epidermolytic palmoplantar keratoderma (PPK) locus associated with oesophageal cancer (TOC)

Focal non-epidermolytic palmoplantar keratoderma (PPK or palmoplantar ectodermal dysplasia type III) is associated with oesophageal cancer in three families: two large pedigrees located in Liverpool, UK and in the midwestern American states and one smaller family from Germany. In these families, the PPK is inherited as autosomal dominant and has a late onset, usually manifesting between 7 and 8 years of age. The disease is characterised by thickening of the pressure areas of the soles, but is not restricted to the feet and also presents with oral leukokeratosis and follicular hyperkeratosis. The disease locus [previously termed the "tylosis oesophageal cancer gene' (TOC) locus] has been mapped to 17q23-qter by linkage analysis. This region is located telomeric to the keratin 16 gene, in which mutations have been identified in focal PPK families who show no increased cancer risk. We describe the close mapping of this locus to the interval between AFMb054zf9 and D17S1603 using haplotype analysis of additional Genethon markers in the region and show that although the American family is unlikely to be related to either of the other two, the UK and German pedigrees may share a common descent. This work provides a basis for positional cloning and candidate gene analysis in order to identify a gene that may be involved in familial oesophageal cancer.      

豆豉多糖对实验性糖尿病小鼠血糖的活性作用

目的:观察豆豉中的多糖类成分对正常小鼠和糖尿病小鼠血糖的影响,探讨其降血糖的活性作用。方法:实验于2006-03/06在华北煤炭医学院药学系实验室完成。选用雄性小白鼠130只,分为3部分进行实验。①治疗性给予豆豉多糖:取30只小鼠制作糖尿病模型。造模成功后随机平均分为模型组、低剂量给药组和高剂量给药组,另取10只作为空白对照组。低剂量和高剂量给药组小鼠分别灌胃豆豉多糖200mg/(kg·d)和400mg/(kg·d),模型组灌胃等体积的生理盐水,空白对照组不采取任何措施。给药4d和7d后测定各组小鼠的血糖水平。②豆豉多糖对正常小鼠血糖的影响:取30只小鼠随机平均分为对照组、低剂量给药组和高剂量给药组。低剂量和高剂量给药组小鼠分别灌胃豆豉多糖200mg/(kg·d)和400mg/(kg·d),对照组灌胃等体积的生理盐水,连续7d。末次给药2h后测定各组小鼠血糖水平。③预防性给予豆豉多糖:取30只小鼠随机平均分为对照组、低剂量给药组和高剂量给药组。低剂量和高剂量给药组小鼠分别灌胃豆豉多糖200mg/(kg·d)和400mg/(kg·d),对照组灌胃等体积的生理盐水,连续4d。灌胃结束后,腹腔注射四氧嘧啶200mg/(kg·d),3d后测定各组小鼠血糖及血清超氧化物歧化酶活性。结果:实验共纳入130只小鼠全部进入结果分析。①治疗性给予豆豉多糖对糖尿病模型小鼠血糖的影响:豆豉多糖灌胃后,模型组小鼠的血糖水平明显高于空白对照组(P<0.01)。给药4d时,高剂量和低剂量给药组与模型组比较,差异有显著性意义(P<0.01,0.05)。在给药7d后,随着多糖浓度的提高,血糖下降越明显,并呈现一定剂量-效应关系。②豆豉多糖对正常小鼠血糖的影响:豆豉多糖可明显降低正常小鼠的血糖水平(P<0.01)。③预防性给予豆豉多糖对糖尿病小鼠血糖及超氧化物歧化酶活性的影响:预防性给予小鼠豆豉多糖有明显的降血糖作用(P<0.01),说明豆豉多糖对糖尿病有一定的预防作用。与对照组比较,豆豉多糖可明显增加小鼠血清超氧化物歧化酶含量,提高超氧化物歧化酶活性。结论:豆豉多糖具有一定的降血糖作用。