How to manage gait and balance disorders among older adults aged 65 years and older with mild to moderate dementia in clinical practice?

Gait and balance disorders are frequent in demented older adults. Their management (i.e., diagnosis, assessment and treatment) is challenging in daily practice because of numerous evaluation tests available, difficulties to select the most adapted intervention, and the lack of knowledge of physicians and health professionals concerning adapted centers to refer their patients to those patients. Thus, a working group of experts was organized by the Gérontop?le of Pays de Loire, France, in December 2010 with the aim to provide clinical guidelines for the management of older adults aged 65 years and older with mild to moderate dementia with gait and balance disorders. These guidelines provide answers to the following questions: 1) Is there gait and/or balance disorders? 2) Which specific tests used? and 3) How to treat patients?     

Simultaneous assessment of liver volume and whole liver fat content: a step towards one-stop shop preoperative MRI protocol

Objective  

The purpose of this study was to evaluate the ability of a whole liver volume (WLV) segmentation algorithm to measure fat fraction (FF).     

Quorum sensing inhibitors increase the susceptibility of bacterial biofilms to antibiotics in vitro and in vivo

Although the exact role of quorum sensing (QS) in various stages of biofilm formation, maturation, and dispersal and in biofilm resistance is not entirely clear, the use of QS inhibitors (QSI) has been proposed as a potential antibiofilm strategy. We have investigated whether QSI enhance the susceptibility of bacterial biofilms to treatment with conventional antimicrobial agents. The QSI used in our study target the acyl-homoserine lactone-based QS system present in Pseudomonas aeruginosa and Burkholderia cepacia complex organisms (baicalin hydrate, cinnamaldehyde) or the peptide-based system present in Staphylococcus aureus (hamamelitannin). The effect of tobramycin (P. aeruginosa, B. cepacia complex) and clindamycin or vancomycin (S. aureus), alone or in combination with QSI, was evaluated in various in vitro and in vivo biofilm model systems, including two invertebrate models and one mouse pulmonary infection model. In vitro the combined use of an antibiotic and a QSI generally resulted in increased killing compared to killing by an antibiotic alone, although reductions were strain and model dependent. A significantly higher fraction of infected Galleria mellonella larvae and Caenorhabditis elegans survived infection following combined treatment, compared to treatment with an antibiotic alone. Finally, the combined use of tobramycin and baicalin hydrate reduced the microbial load in the lungs of BALB/c mice infected with Burkholderia cenocepacia more than tobramycin treatment alone. Our data suggest that QSI may increase the success of antibiotic treatment by increasing the susceptibility of bacterial biofilms and/or by increasing host survival following infection.     

Myocardial infarction: Role of new antiplatelet agents

Thienopyridines have become the cornerstone of treatment of percutaneous coronary intervention although no survival benefit has ever been shown with clopidogrel despite increasing loading doses. Newly developed P2Y(12)?inhibitors are more potent, more predictable and have a faster onset of action than clopidogrel, characteristics that make them particularly attractive for high-risk PCI. Four new P2Y(12)?inhibitors have been tested each of them having particular individual properties. Prasugrel is an oral prodrug leading to irreversible blockade of the P2Y(12)?receptor and is approved worldwide for ACS PCI. Ticagrelor is a direct-acting and reversible inhibitor of the P2Y(12)?receptor with potentially more pleiotropic effects. Cangrelor is an intravenous direct and reversible inhibitor of the P2Y(12)?receptor providing the highest level of inhibition and elinogrel is an intravenous and oral P2Y(12)?antagonist with a direct and reversible action. Both prasugrel and ticagrelor, opposed to clopidogrel, have shown that stronger P2Y(12)?inhibition led respectively to significant 19?% and 16?% relative risk reduction of a similar primary endpoint combining cardiovascular death, nonfatal myocardial infarction, or nonfatal stroke. Both drugs showed a significant 0.6?% absolute excess of TIMI major bleeding not related to CABG surgery. The effect of these new compounds is prompt, predictable and powerful as compared to clopidogrel. Their net benefit is particularly marked in PCI for STEMI patients, in which there is no significant increase in major bleeding when compared with clopidogrel. However, because in clinical trials patients perceived to be at higher risk for bleeding usually are excluded, the risk of major and even fatal bleeding might even be higher in a "real-world" setting i.e. in the elderly patient with comorbidities.     

Relationships between weight loss and circulating cytokines in patients with Alzheimer's disease

106 consecutive patients with Alzheimer's disease living in the community were examined in a memory clinic from a neurological department. They were screened for weight loss over the last 2 years. Age, duration of the disease, behavioral disorders, mini mental status examination, body mass index were recorded. Tumor necrosis factor alpha (TNFalpha), interleukin-1beta (IL-1beta), interleukin 6 (IL-6) and interleukin 2 (IL-2) blood levels were measured. Weight loss was reported in 42.5% of the patients. TNFalpha levels were significantly higher in these patients (18.8 versus 15.8 pg/mL; p=0.04) than in patients without weight loss. Weight loss was also associated with a lower MMSE score (16.9 versus 19.3; p=0.03), current pacing (20% versus 1.6%; p=0.002), and hallucinations (20.0% versus 3.3%; p=0.008). The levels of the other cytokines did not differ between the patients with and without weight loss. Our findings suggest an association between high levels of circulating TNFalpha and unexplained weight loss in Alzheimer's disease.     

Posterior leaflet preservation in mitral valve prolapse: a new approach to mitral repair

The most common repair technique for P2 prolapse is quadrangular resection of the posterior leaflet associated with a plication of the mitral annulus or with a sliding plasty. Although effective, these techniques do not respect the anatomy of the mitral valve, especially the physiological role of the posterior leaflet. Herein is described another technique which does not include P2 removal, thus preserving the posterior leaflet mobility. This technique represents a new approach to mitral valve repair that respects the motion of the two leaflets, allowing a more physiological opening of the mitral valve.