Individual's perspective of local community environment and health indicators in older adults

Aim: This study evaluated the relationship between individual's perspective of local community environment and health in older people. Methods: A survey about quality of life in older adults in Spain was applied to a representative sample of 1106 community‐dwelling people (mean age ± SD = 72.07 ± 7.83 years, 43.67% males). Local community (Community Wellbeing Index, neighborhood problems, time in the neighborhood), psychosocial and sociodemographic measures were considered. Four health outcomes (self‐perceived health status, functional independence, depression and number of chronic medical conditions) were studied. Multivariate logistic analyses were carried out. Results: At least two local community measures were independently associated with each health outcome. Satisfaction with community services significantly contributed to all models; it was positively related with self‐rated health and functional independence, and negatively associated with depression and chronic medical conditions. Conclusion: The individual's perspective of the local community environment was associated with health outcomes in older adults. This can be useful in the development of policies committed to promoting social integration and active aging in the community. Geriatr Gerontol Int 2013; 13: 130–138 .     

Kikuchi-Fujimoto disease: a case supporting a role for human herpesvirus 7 involvement in the pathogenesis

Kikuchi’s disease, also known as histiocytic necrotizing lymphadenitis, is a rare, benign, and self-limited disorder of unknown cause that is usually characterized by cervical lymphadenopathy and fever. The etiology and pathogenesis remain unknown, but the clinical presentation, course, and histologic changes suggest an immune response of T cells and histiocytes to an infectious agent. Numerous inciting agents have been proposed. However, the association between human herpesvirus 7 and Kikuchi’s disease has been rarely reported as a possible etiologic agent of Kikuchi’s disease. We report the case of a 24-year-old Caucasian female patient with cervical lymphadenopathy and isolated pruriginous maculo-papular lesions who was diagnosed of Kikuchi’s disease in whom the presence of human herpesvirus 7 DNA was documented in the affected lymph node specimen in the absent of other viruses. Therefore, a possible etiologic relation between the Kikuchi’s disease of this patient and human herpesvirus 7 was established, supporting a role for human herpesvirus 7 involvement in the pathogenesis.     

Effect of statin treatment on coronary plaque progression – A serial coronary CT angiography study

Objectives

Statins have been shown to reduce plaque progression using data on intravascular ultrasound, carotid intima-media thickness and coronary artery calcium scans. However, there is little data on effects of statins on plaque progression using Coronary CTA. The objective is to evaluate the effect of statin therapy on plaque progression using serial Coronary CTA (CCTA).

Methods

The study included 100 consecutive patients who underwent serial Coronary CTA (mean follow up: 406 ± 92 days) for evaluation of CAD without known prior heart disease or revascularization. We performed volumetric assessment of low attenuation plaque (LAP < 30 Hounsfield units), non-calcified (NCP) and calcified plaque volumes at baseline and follow up scans for vessels >2 mm in diameter. Patients who received statins were compared to those that did not.

Results

Total plaque progression was significantly reduced among statin user compared to non-statin users (−33.3 mm³ ± 90.5 vs. 31.0 mm³ ± 84.5, p = 0.0006). Statin users had significantly reduced progression of NCP volume (−47.7 mm³ ± 71.9 vs. 13.8 mm³ ± 76.6, p < 0.001) and significantly reduced progression of LAP volume (−12.2 mm³ ± 19.2 vs. 5.9 mm³ ± 23.1, p < 0.0001). When we compared for remodeling index, no statistical difference was found between the two groups (p = 0.25) and a non-significant trend toward calcium progression (29.3 mm³ ± 67.9 vs. 10.0 mm³ ± 53.2, p = 0.133). After adjustment for cardiovascular risk factors, mean plaque volume difference between statin and non-statin users was statistically significant for both LAP and NCP volumes (−18.1, 95% CI: −26.4, −9.8 for LAP; −101.7, 95% CI: −162.1, −41.4 for NCP; p < 0.001) respectively.

Conclusion

Statin therapy resulted in significantly lower progression of LAP and NCP plaques compared to non-statin users.     

Increased p53 gene dosage reduces neointimal thickening induced by mechanical injury but has no effect on native atherosclerosis

OBJECTIVE: The tumor suppressor p53 regulates cell proliferation and apoptosis, two key processes in the pathogenesis of occlusive vascular disease. Here, we examined the consequences of heightening p53 function on neointimal lesion formation in the setting of atherosclerosis and mechanical injury. METHODS: For this study we employed immunohistopathological characterization of neointimal lesions in atherosclerosis-prone apolipoprotein E-null mice with normal p53 gene dosage (apoE-KO) and carrying a p53 transgene (Super-p53/apoE-KO). We also carried out molecular studies in macrophages and smooth muscle cells (SMCs) obtained from these mice. RESULTS: The p53 transgene conferred p53 gain-of-function in cultured cells and mice. In vitro, survival of irradiated Super-p53 macrophages and femoral SMCs was reduced, but only Super-p53 SMCs exhibited attenuated proliferation. In vivo, whereas the size of spontaneously formed and diet-induced aortic atheromas was indistinguishable in apoE-KO and Super-p53/apoE-KO mice, the latter exhibited attenuated neointimal thickening in mechanically injured femoral artery. In both models, neither apoptosis nor cell proliferation were affected by additional p53 gene dosage when examined in established neointimal lesions. However, at 2 days after mechanical injury when neointimal lesions were not yet formed, cell proliferation was significantly attenuated within medial SMCs of Super-p53/apoE-KO mice. CONCLUSION: Heightening p53 function has differential effects on in vitro proliferation of macrophages (unaffected) versus SMCs (reduced), and on native atherosclerosis (unaffected) versus mechanically induced neointimal thickening (reduced) in apoE-KO mice. The protective effect of p53 in mechanically injured femoral artery coincided with limited medial SMC proliferation at early time points preceding neointima formation, but neither medial nor neointimal cell proliferation was affected in vessels with established occlusive lesions. These findings corroborate p53 gain-of-function as a promising therapeutic strategy to limit post-angioplasty restenosis but not native atherosclerosis.     

Cost comparison of robotic, video-assisted thoracic surgery and thoracotomy approaches to pulmonary lobectomy

The financial impact of employing minimally invasive techniques for lobectomy compared with traditional open thoracotomy was assessed. A retrospective review was conducted using ICD9 codes for thoracotomy, video-assisted thoracic surgery (VATS), and robotic VATS lobectomy to determine total average costs associated with the resultant hospital stay. The difference in total average costs was calculated for each group. Robotic VATS lobectomy had higher associated costs than VATS only, primarily attributed to increased costs of the first hospital day, but was still less costly than thoracotomy. The average cost of VATS is substantially less than thoracotomy primarily because of a decreased length of stay. The cost of robotic assistance for VATS is still less than thoracotomy, but greater than VATS alone.     

The Efficacy and Safety of Ezetimibe for Treatment of Dyslipidemia After Heart Transplantation

Introduction

Statins, although the treatment of choice for dyslipidemia after heart transplantation (HT), are not always well tolerated or effective. In such cases, administration of ezetimibe may be useful.

Aim

The aim of this study was to assess the efficacy and safety of ezetimibe, with or without statins, after HT.

Method

Thirty-six HT patients, 97% of whom were males of overall mean age of 57 ± 13 years, were all unable to reach target lipid levels with statins alone and/or were intolerant of statins. They were prescribed ezetimibe, with or without a statin. Efficacy and safety were evaluated after 1, 3, 6, and 12 months.

Results

Thirty-four patients were evaluated at 1 month and 12 months. Ezetimibe was prescribed to 27 patients (75%) because of statin inefficacy, and to 9 patients (25%) because of statin intolerance, manifested by myalgia in 4 cases (11%), hepatotoxicity in 2 cases (6%), and rhabdomyolysis in 3 cases (8%). Lipid levels (mg/dL; baseline vs 1 year) were as follows: cholesterol, 235 ± 49 versus 167 ± 32 (P = .013); LDL cholesterol, 137 ± 47 versus 89 ± 29 (P = .001); HDL cholesterol, 54 ± 13 versus 51 ± 10 (P = .235); and triglycerides, 243 ± 187 versus 143 ± 72 (P = .022). There were no cases of liver toxicity, renal dysfunction, or significant alteration of immunosuppressive pharmacokinetics. Ezetimibe was withdrawn from 2 patients because of hand edema or asymptomatic recurrence of rhabdomyolysis first caused by statins.

Conclusions

With or without a statin, ezetimibe was generally well tolerated, reducing total cholesterol, LDL cholesterol, and triglyceride levels with no long-term alteration of HDL cholesterol levels. CPK surveillance is recommended because of a slight continued risk of adverse effects. Further studies should evaluate the benefit for survival.     

The multiply injured patient

The multiply injured patient with significant thoracic and extra-thoracic injuries poses a number of challenges. Pericardial tamponade, tension pneumothorax and massive hemothorax can and should be diagnosed clinically. In more stable patients, chest computed tomography (CT) scan is an excellent screening test. The concept of damage control resuscitation and damage control surgery have shown promise in patients with multiple, critical injuries. Beta-blockade of patients with blunt thoracic aortic injuries can be used as a temporizing damage control measure when the risks of operation or intervention are very high (traumatic brain injury, severe right or bilateral pulmonary contusion, unstable pelvic fractures). Patients with multiple penetrating wounds require the surgical team to be expeditious and flexible, and damage control is a helpful strategy in these patients.