Chemical Dependence and Substance Abuse on a Geropsychiatric Unit: A Preliminary Study

Medical records of 125 geropsychiatric inpatients were reviewed for a pilot study of the prevalence and medical and psychosocial correlates of chemical dependence and/or abuse. Patients were studied in three groups, each corresponding to the phased implementation of a program to enhance staff awareness of these problems. In contrast to patients without chemical dependence/abuse diagnoses, patients with these diagnoses had shorter lengths of stay, a greater number of psychiatric diagnoses, and were more likely to show personality disorder. Inception and implementation of the staff awareness program was associated with finding a significantly greater number of patients with chemical dependence/abuse diagnoses.     

Prognostic and Practical Validation of Current Definitions of Myocardial Infarction Associated With Percutaneous Coronary Intervention

Objectives

In 13,038 patients with non–ST-segment elevation acute coronary syndrome undergoing index percutaneous coronary intervention (PCI) in the EARLY ACS (Early Glycoprotein IIb/IIIa Inhibition in Non–ST-Segment Elevation Acute Coronary Syndrome) and TRACER (Thrombin Receptor Antagonist for Clinical Event Reduction in Acute Coronary Syndrome) trials, the relationship between PCI-related myocardial infarction (MI) and 1-year mortality was assessed.

Development of a novel transgenic mouse/SCID-hu mouse system to characterize the in vivo behavior of reservoirs of human immunodeficiency virus type 1-infected cells

To develop a system in which transgenic and knockout technologies are used to study the in vivo behavior of human immunodeficiency virus type 1 (HIV-1) reservoirs, 2 different mouse models were combined: transgenic mice carrying full-length provirus encoding the monocyte-tropic HIV-1(JR-CSF) isolate (JR-CSF mice) and severe combined immunodeficient mice implanted with human fetal thymus and liver tissues (thy/liv-SCID-hu mice). Extensive HIV-1 infection of human thymic implants occurred after injection of JR-CSF mouse leukocytes into thy/liv-SCID-hu mice, indicating that these cells provide an in vivo source of replication-competent HIV-1. In vivo persistence of transferred JR-CSF mouse leukocytes carrying replication-competent HIV-1 in thy/liv-SCID-hu mice was indicated by the emergence of HIV-1 infection in mice that had no detectable HIV-1 infection until after highly active antiretroviral therapy. Thus, thy/liv-SCID-hu mice populated with JR-CSF mouse leukocytes, a persistent cellular reservoir harboring replication-competent HIV-1, present a new in vivo system for characterizing reservoirs of HIV-1 and evaluating therapeutic strategies designed to eliminate them.     

Human embryonic-derived hematopoietic repopulating cells require distinct factors to sustain in vivo repopulating function

OBJECTIVE: We have previously identified a novel circulating embryonic blood cell capable of pluripotent hematopoietic reconstitution, which may serve as a target for in utero stem cell therapy. Based on its unique biological properties and ontogenic origin, we aim to examine the ability to maintain and retrovirally transduce fetal blood (FB) reconstituting cells in ex vivo culture conditions previously optimized for pluripotent hematopoietic repopulating cells derived from later stages of human ontogeny. METHODS: FB cells were evaluated for proliferative potential, progenitor composition, and SCID-repopulating cell (SRC) capacity before and after 3 days of serum free (SF) ex vivo culture using the previously optimized growth factor conditions of SCF, Flt-3L, IL-3, IL-6, and G-CSF (GF Mix), in comparison to cultures using GF Mix + oncostatin M (OSM), or SCF + Flt-3L. We further examined the ability to retrovirally transduce FB-SRC maintained in culture using SCF + Flt-3L alone. RESULTS: Circulating FB-SRC could not be maintained under GF Mix conditions previously shown to sustain CB (cord blood)-SRC. Ex vivo culture with SCF + Flt-3L reduced the proliferation of primitive FB cells lacking lineage commitment markers (Lin(-)), but expanded FB progenitors and sustained FB-SRC compared to culture with GF Mix with and without OSM. Using SCF + Flt-3L, FB-SRC capable of multilineage reconstitution were successfully transduced, suggesting that SCF and Flt-3L are necessary and sufficient for the survival and transduction of human hematopoietic repopulating cells of embryonic origin. CONCLUSION: Our study provides novel insights into the requirements of primitive FB reconstituting cells that are essential for developing in utero stem cell gene therapy protocols, and further illustrates the biological distinctiveness of FB-SRC compared to hematopoietic repopulating cells from other stages of human ontogeny.     

Mid-Thigh Cortical Bone Structural Parameters,Muscle Mass and Strength,and Association with Lower Limb Fractures in Older Men and Women (AGES-Reykjavik Study)

In a cross-sectional study we investigated the relationship between muscle and bone parameters in the mid-thigh in older people using data from a single axial computed tomographic section through the mid-thigh. Additionally, we studied the association of these variables with incident low-trauma lower limb fractures. A total of 3,762 older individuals (1,838 men and 1,924 women), aged 66–96 years, participants in the AGES-Reykjavik study, were studied. The total cross-sectional muscular area and knee extensor strength declined with age similarly in both sexes. Muscle parameters correlated most strongly with cortical area and total shaft area (adjusted for age, height, and weight) but explained <10 % of variability in those bone parameters. The increment in medullary area (MA) and buckling ratio (BR) with age was almost fourfold greater in women than men. The association between MA and muscle parameters was nonsignificant. During a median follow-up of 5.3 years, 113 women and 66 men sustained incident lower limb fractures. Small muscular area, low knee extensor strength, large MA, low cortical thickness, and high BR were significantly associated with fractures in both sexes. Our results show that bone and muscle loss proceed at different rates and with different gender patterns.     

The role of fat grafting in reconstructive and cosmetic breast surgery: a review of the literature

The technique of autologous fat transplantation has been dramatically improved since its first introduction in 1893. This surgical approach has more recently been used in both the reconstructive and cosmetic setting, and has subsequently been the subject of much controversy. We sought to compose a detailed and systematic literature review of recent literature on the topic in order to provide surgeons with the data in an organized and easily accessible manner. We selected 19 studies and systematically documented trends in their methods, follow-up procedures, and outcomes, paying particular attention to complications. We chose to include studies that analyzed the outcomes of the surgical procedure in both reconstructive and cosmetic cases. Most authors reported satisfactory or greater results, and we concluded that it appears as though autologous fat transplantation to the breast is a safe option for patients seeking both reconstructive and cosmetic surgery.     

Oral bisphosphonate use in the elderly is not associated with acute kidney injury

Intravenous bisphosphonates can cause acute kidney injury; however, this risk was not found with oral bisphosphonates in randomized clinical trials with restrictive eligibility criteria. In order to provide complementary safety data, we studied the risk of acute kidney injury in a population-based cohort of 122,727 patients aged 66 years and older discharged from hospital following a new fragility fracture and no history of bisphosphonate use in the prior year. Bisphosphonate treatment was identified within 120 days after discharge and event rates were measured from 90 days of therapy initiation. The primary outcome was hospitalization with acute kidney injury with secondary outcomes of new nephrology consultation and, in a subset of patients with laboratory values, acute kidney injury was defined as an increase in serum creatinine. We identified 18,286 bisphosphonate users and 104,441 non-users with a mean age of 81 years. Of 5772 patients with laboratory values, 40% had chronic kidney disease (eGFR <60?ml/min per 1.73?m(2)). Overall, there was no statistically significant difference in the risk of acute kidney injury among bisphosphonate users compared to non-users (adjusted odds ratio 1.03), and no significant differences in other outcomes or in subgroups of patients with baseline chronic kidney disease. Thus, in this older population-based cohort, oral bisphosphonate use was not associated with acute kidney injury.