Delayed diagnosis of meningitis caused by beta-haemolytic group G. Streptococcus in an older woman.

A case of meningitis caused by group G β-hemolytic Streptococcus (dysgalactiae, subspecies equisimilis) is reported in an 83-year-old woman. Streptococci species other than Streptococcus pneumoniae are seldom found in patients with acute bacterial meningitis, therefore, our discussion is focused on this rare organism. The question of the diagnosis of meningitis in the elderly is also addressed.     

Prevalence and Correlates of Nocturia in Community‐Dwelling Older Adults

OBJECTIVES: To determine the prevalence and correlates of nocturia in community‐dwelling older adults. DESIGN: Planned secondary analysis of cross‐sectional data from the University of Alabama at Birmingham Study of Aging population‐based survey. SETTING: Participants' homes. PARTICIPANTS: One thousand older adults (aged 65–106) recruited from Medicare beneficiary lists between 1999 and 2001. The sample was selected to include 25% each African‐American women, African‐American men, white women, and white men. MEASUREMENTS: In‐person interviews included sociodemographic information, medical history, Mini‐Mental State Examination (MMSE) score, and measurement of body mass index (BMI). Nocturia was defined in the main analyses as rising two or more times per night to void. RESULTS: Nocturia was more common in men than women (63.2% vs 53.8%, odds ratio (OR)=1.48, 95% confidence interval (CI)=1.15–1.91, P=.003) and more common in African Americans than whites (66.3% vs 50.9%, OR=1.89, 95% CI=1.46–2.45, P<.001). In multiple backward elimination regression analysis in men, nocturia was significantly associated with African‐American race (OR=1.54) and BMI (OR=1.22 per 5 kg/m²). Higher MMSE score was protective (OR=0.96). In women, nocturia was associated with older age (OR=1.21 per 5 years), African‐American race (OR=1.64), history of any urine leakage (OR=2.17), swelling in feet and legs (OR=1.67), and hypertension (OR=1.62). Higher education was protective (OR=0.92). CONCLUSION: Nocturia in community‐dwelling older adults is a common symptom associated with male sex, African‐American race, and some medical conditions. Given the significant morbidity associated with nocturia, any evaluation of lower urinary tract symptoms should include assessment for the presence of nocturia.     

The Practice of Continuous Palliative Sedation in Elderly Patients: A Nationwide Explorative Study Among Dutch Nursing Home Physicians

OBJECTIVES: To study the practice of continuous palliative sedation (CPS) by Dutch nursing home physicians in 2007. DESIGN: A structured retrospective questionnaire. SETTING: Nationwide nursing home physician study in the Netherlands. PARTICIPANTS: One thousand two hundred fifty‐four nursing home physicians received a questionnaire concerning their last case of CPS in 2007; 54% (n=675) responded. MEASUREMENTS: Characteristics of CPS and requests for euthanasia were measured. RESULTS: Three hundred sixteen patients were described. The majority had cancer or dementia. The most‐reported refractory symptoms were pain (52%), anxiety (44%), exhaustion (44%), dyspnea (40%), delirium (24%), loss of dignity (18%), and existential distress (16%). In 98% of cases, CPS was aimed at symptom relief. Of patients with cancer, 17% had previously requested euthanasia. The mean starting dose of midazolam was 31 mg every 24 hours (range 0–240 mg/24 h), and the mean end dose was 48 mg every 24 hours (range 0–480 mg/24 h). CONCLUSION: In addition to physical symptoms, anxiety, exhaustion, loss of dignity, and existential distress are often mentioned as refractory symptoms in the decision to start CPS by nursing home physicians. Furthermore, close to one in five patients with cancer had made a previous request for euthanasia. The dosage range of midazolam in this study fits the recommendations of the Dutch national guideline on palliative sedation, although international studies show smaller dosage ranges. Finally, prospective research about the acceptability and assessment of nonphysical symptoms as indications for CPS is recommended.     

Body Mass Index and Survival in Men and Women Aged 70 to 75

OBJECTIVES: To examine in an older population all‐cause and cause‐specific mortality associated with underweight (body mass index (BMI)<18.5), normal weight (BMI 18.5–24.9), overweight (BMI 25.0–29.9), and obesity (BMI≥30.0). DESIGN: Cohort study. SETTING: The Health in Men Study and the Australian Longitudinal Study of Women's Health. PARTICIPANTS: Adults aged 70 to 75, 4,677 men and 4,563 women recruited in 1996 and followed for up to 10 years. MEASUReMENTS: Relative risk of all‐cause mortality and cause‐specific (cardiovascular disease, cancer, and chronic respiratory disease) mortality. RESULTS: Mortality risk was lowest for overweight participants. The risk of death for overweight participants was 13% less than for normal‐weight participants (hazard ratio (HR)=0.87, 95% CI=0.78–0.94). The risk of death was similar for obese and normal‐weight participants (HR=0.98, 95% CI=0.85–1.11). Being sedentary doubled the mortality risk for women across all levels of BMI (HR=2.08, 95% CI=1.79–2.41) but resulted in only a 28% greater risk for men (HR=1.28 (95% CI=1.14–1.44). CONCLUSION: These results lend further credence to claims that the BMI thresholds for overweight and obese are overly restrictive for older people. Overweight older people are not at greater mortality risk than those who are normal weight. Being sedentary was associated with a greater risk of mortality in women than in men.     

Incidence and Risk Factors for Fecal Incontinence in Black and White Older Adults: A Population‐Based Study

OBJECTIVES: To determine the incidence of fecal incontinence (FI) in community‐dwelling older adults and identify risk factors associated with incident FI. DESIGN: Planned secondary analysis of a longitudinal, population‐based cohort study. SETTING: Three rural and two urban Alabama counties (in‐home assessments 2000–2005). PARTICIPANTS: Stratified random sample of 1,000 Medicare beneficiaries: 25% African‐American men, 25% white men, 25% African‐American women, 25% white women, aged 65 and older. Eligible participants for this analysis were continent at baseline and community‐dwelling 4 years later (n=557). MEASUREMENTS: FI was defined as any loss of control of bowels occurring during the previous year. Independent variables were sociodemographics, Charlson comorbidity counts, self‐reported bowel symptoms (chronic diarrhea and constipation), depression, and body mass index (BMI). Multivariable logistic regression models were constructed using incident FI as the dependent variable. RESULTS: The incidence rate of FI at 4 years was 17% (95% confidence interval (CI)=13.7–20.1), with 6% developing FI at least monthly (95% CI=4.0–8.3). White women were more likely to have incident FI (22%) than African‐American women (13%, P=.04); no racial differences were observed in men. Controlling for age, comorbidity count, and BMI, significant independent risk factors for incident FI in women were white race, depression, chronic diarrhea, and urinary incontinence (UI). UI was the only significant risk factor for incident FI in men. CONCLUSION: The occurrence of new FI is common in men and women aged 65 and older, with a 17% incidence rate over 4 years. FI and UI may share common pathophysiologic mechanisms and need regular assessment in older adults.     

Factors affecting dietary intake and nutritional status of tenants in sheltered housing

Two hundred and thirty-five sheltered housing tenants (59 men and 176 women) were studied to investigate the relationship between age, sex, marital status, living arrangement, mobility, self care ability, mood, cognitive function and social engagement, and energy and nutrient intake and ratio of weight to demi-span. Men had higher energy intakes than women and energy intake had an inverse relationship to age. There was a decline in the weight to demi-span ratio with age which was statistically significant only in women. There was no relationship between physical, mental and social characteristics, and nutritional or anthropometric status.     

The effect of oral vitamin D supplementation on plasma 25 hydroxy vitamin D in institutionalized elderly patients in a subtropical climate–a twelve-month follow-up

Plasma 25 hydroxy Vitamin D (25 [OH]D) concentrations were studied in a group of 29 nursing home residents (age range 56 to 93 years) in a subtropical climate (Brisbane, Australia) before and after oral supplementation of 37.6 nmol of vitamin D per day over a 12-month period. Eleven of the 29 subjects had pretreatment 25 ([OH]D) concentrations of less than 25 nmol/1. There was a significant rise in 25[OH]D concentrations from a baseline of 33.5 ±21.25 nmol/1 (mean±standard deviation) to 62.25±18 nmol/1 (P<0.001) while there was no significant change in calcium, phosphate and alkaline phosphatase concentrations during the 12 months. In this population, the daily supplement was efficacious in correcting vitamin D deficiency and in no case was there biochemical evidence of toxicity.     

THE NUCLEUS BASALIS IN ALZHEIMER'S DISEASE: CELL COUNTS AND CORTICAL BIOCHEMISTRY

The cell density in the Nucleus Basalis in six patients with clinical and histological evidence of Alzheimer's disease and reduced choline acetyltransferase activity in frontal and temporal cortex was found to be in approximately 50% of the cell count in five control subjects.     

GICR-IACPR心血管疾病预防和康复最佳心理实践意见书精要

2018年10月,意大利心血管预防康复和流行病学协会（GICR-IACPR）发表了“心血管疾病预防和康复（CPR）最佳心理实践意见书（以下简称意见书）”。意见书借鉴英国国家健康和护理研究所（NICE）焦虑抑郁障碍心理干预指南,将CPR中的心理实践分为3步：心理评估及动态监测;低强度干预,适用于较轻疾病或近期发病的患者;高强度干预,适用于低强度干预效果不佳或随时间推移病情恶化的患者。将心理干预分为两级,低强度干预：咨询、心理教育、自我保健、自我管理、远程医疗、自我帮助等;高强度干预：个人、夫妻、家庭和团体心理治疗、压力管理等。该意见书综述了大量最新的文献和指南,可操作性强,与我国当前心脏康复实践中的心理处方相比,内容更加全面细致,可为国内从事CPR的心理工作人员提供规范参考。     

Mechanism of cellular senescence in acute kidney injury that leads to chronic kidney disease in elderly mice

Objective To investigate the mechanism of cellular senescence in ischemia reperfusion injury (IRI)-induced acute kidney injury (AKI) that leads to chronic kidney disease (CKD) in elderly mice. Methods An acute kidney injury model was established in C57Bl/6 male mice at ages 8-10 weeks (young group) or 20-24 months (old group) by bilateral IRI. The animals were randomly divided into 4 groups as follows: Young-Sham (n=8), Old-Sham (n=8), Young-IRI (n=8), and Old-IRI groups (n=8). All mice were weighted, and their blood was collected from the tail vein at days 1, 3, and 7 after surgery. The mice were killed on day 14 after surgery, and their kidneys were harvested for further analysis. Serum was used for the creatinine test. The changes of the renal tissue morphology and pathology were assessed using hematoxylin-eosin staining and sirius red staining. Immunofluorescence staining of collagenⅠ, F4/80, phosphor-histone H3 (p-HH3), and Ki67 were performed to determine the stage of the collagen deposit, macrophage filtration, and cell cycle G2/M arrest. The collagenⅠ expression was analyzed using western blot. The expression levels of TNF-α, IL-6, TGF-β, and collagenⅠ were determined using real-time PCR. Results Compared with that in the sham group, the serum creatinine levels in both Young-IRI and Old-IRI groups were obviously increased. The Young-IRI group recovered completely on day 7. The Old-IRI group had higher creatinine levels than the Young-IRI group at each time point. Morphology and pathology analyses revealed that acute injury was repaired in the Young-IRI group, but slight inflammatory cell filtration and collagen deposition were observed in the Old-Sham and Old-IRI groups, respectively. Immunofluorescence staining revealed some F4/80-positive macrophage filtration, collagenⅠdeposition, and p-HH3 and Ki67 double-positive nuclear tubular epithelial cells in the Old-Sham group, but considerably more positive results were found in the Old-IRI group. Western blot analysis revealed that collagenⅠ expression level was higher in the Old-IRI group than in the Young-IRI group (P＜0.01) and in the Old-Sham group than in the Young-Sham group (P＜0.05). Real-time PCR demonstrated that the mRNA expression levels of cytokines and fibrosis markers, including of TNF-α, IL-6, TGF-β, and collagenⅠ, in the Old-Sham and Old-IRI groups were increased as compared with those in the Young-Sham and Young-IRI groups (P＜0.05). Conclusions The levels of kidney inflammation, fibrosis, and cell-cycle arrest are lower in the old mice. After IRI injury, a sustained and ongoing inflammatory reaction is involved and more cells are arrested in the cell cycle G2/M, which inhibit renal repair and promote fibrosis progression.