Understanding the financial impact of a diagnosis of young onset dementia on individuals and families in the United Kingdom: Results of an online survey

Although literature on postdiagnostic support for people affected by young onset dementia acknowledges financial concerns, this topic has remained underresearched. The aim of this study was to explore the financial impact of a diagnosis of young onset dementia on individuals and families. An online survey, comprising binary yes/no, multiple-response and open-ended questions, was codesigned with people living with young onset dementia. The survey was promoted via networks and online platforms. Data were collected from August to October 2019. Survey respondents across the United Kingdom (n = 55) who had received a diagnosis of young onset dementia were aged between 45 and 64, were at different stages of dementia and had been diagnosed with thirteen different types of dementia. Of the 55 respondents, 71% (n = 39) had received assistance from family members when completing the survey. The main financial impact of a diagnosis of young onset dementia resulted from premature loss of income and reduced and often deferred pension entitlements. In some cases, care-costs became unaffordable. Lack of clarity of processes and procedures around needs assessments, carers' assessments and financial assessments by different organisations resulted in some families having to ask for legal advice and, in some cases, involved lengthy appeal processes. Future research needs to involve Adult Social Care and Third Sector organisations to help codesign and test financial management interventions to support people affected by this progressive health condition.     

心血管参数对动脉中压力和流量的影响

本文从建立心室-血管优化耦合模型出发,通过求解优化耦合所对应主动脉根部的压力和流量所满足方程,详细讨论动脉中压力和流量随心血管参数的变化规律,所得结果与血液循环系统的生理事实一致。     

Intracellular targeting and protein kinase C in vascular smooth muscle cells: specific effects of different membrane-bound receptors

Protein kinase C is an important second messenger system, which is translocated from the cytosol to the cell membrane upon cell stimulation. We used confocal microscopy to study the spatial distribution of protein kinase C isoforms after stimulation of cultured vascular smooth muscle cells with different agonists. First, we analysed the effects of angiotensin II and platelet-derived growth factor (PDGF). Confocal microscopy showed a rapid assembly of PKC α along cytosolic fibres followed by a translocation towards the nucleus with angiotensin II. PDGF engendered a similar, but much slower response; however, a cytoskeletal distribution was not observed. We then investigated the effects of thrombin and bFGF on nuclear translocation. bFGF induced a rapid translocation of the isoform towards the perinuclear region and into the nucleus. bFGF had a similar effect on PKC ?. In contrast, thrombin had a smaller effect on nuclear translocation of PKC α and did not influence PKC ?, but instead induced a rapid nuclear translocation of PKC ζ. Thus, tyrosine kinase receptor activation via bFGF induces a rapid association of PKC α and ? within nuclear structures. Our results show that agonists cause, not only a translocation of protein kinase C isoforms into the cell membrane but also into the cell nucleus. Lastly, we analyzed the nuclear immunoreactivity of the PKC isoforms α, δ,? and ζ in vascular smooth muscle cells during the cell cycle. Resting cells were stimulated with foetal calf serum (FCS, 10%), which translocated PKC α and ? to the perinuclear region and into the nucleus, while PKC δ and ζ showed no increase in nuclear immunoreactivity. After 4 h of FCS, the nuclear immunoreactivity for PKC α and ? was reduced to or below control values. At 8 h, increased nuclear expression of isoforms α,? and ζ was observed, while isoform δ was not affected. Our results demonstrate a complex spatial and temporal regulation of PKC isoforms in response to vasoactive hormones and growth factors. We suggest that protein kinase C may be important for nuclear signaling and demonstrate that nuclear translocation of PKC isoforms is differentially regulated during the cell cycle.     

Hepatic arterial variations and liver-related diseases of 100 consecutive donors

We prospectively studied anatomical variations and diseases of the liver in 100 consecutive donor operations during a period of 1 year. The normal arterial anatomy with a single hepatic artery (HA) from the celiac trunk was seen in 76% of all cases. Seven of twelve different major variations of the HA may be considered as rare, one of which cannot be found in the earlier literature. During harvesting, 6% of the livers were discarded, 3% on the basis of infection and 1% because of a polycystic disease. Two cases were rejected as the liver was found to be severely hypoperfused or hypoxic in an otherwise stable donor. Severe steatosis was macroscopically and histologically diagnosed in 3% of the cases, and in three donors a benign tumour was found in the liver or in the gall bladder. Two primarily nonfunctioning livers in the present series of 94 recipient operations were retrieved from this group of severely steatotic livers. As the donor liver was totally normal in only 2 out of 3 of the cases, the present study underlines the importance of searching for extremely variable anomalies of the HA and for liver-related diseases during organ harvesting.     

电针肾俞、膈俞、百会穴对拟血管性痴呆学习记忆障碍小鼠水迷宫实验的影响

目的　观察电针肾俞、膈俞、百会穴对拟血管性痴呆小鼠学习记忆障碍的影响。方法　复制脑缺血再灌注拟血管性痴呆小鼠模型 ,并电针肾俞、膈俞、百会穴 ,分别于术后 7天、15天、30天 ,与药物喜德镇对照 ,采用水迷宫法 ,记录游全程时间、错误次数。结果　造模导致了小鼠学习与记忆能力下降 ,表现为游全程时间延长 ,错误次数增加 ,且随着观察时间的延长 ,这种改变逐渐加重。电针和喜德镇均可使模型小鼠的游全程时间缩短 ,错误次数减少 ,但电针组于 7天和 30天时 ,成绩显著优于药物组。结论　电针肾俞、膈俞、百会穴对模型小鼠学习与记忆能力下降有改善和提高作用     

Amyloid-P-component-like immunoreactivity in β/A4-immunoreactive deposits in Alzheimer-type dementia brains

An immunohistochemical study using the mirror-image technique was performed in order to establish whether amyloid P component is involved in the mechanism of deposition of amyloid fibrils in senile plaques (SPs) in Alzheimer-type dementia (ATD). Ninety percent of /A4 protein-immunoreactive SPs were also stained by the anti-amyloid P component immunchistochemistry, and this applied to all of the diffuse, primitive and classical types of /A4 deposits. These findings may suggest an involvement of amyloid P component in the formation of amyloid fibrils in senile plaques in ATD brains.     

Neuronal mechanisms of the attentional dysfunctions in senile dementia and schizophrenia: two sides of the same coin?

Deficits in early stages of information processing, specifically the inability to disattend irrelevant stimuli and to selectively allocate processing resources (i.e., hyperattention), have been associated with the development of psychotic symptoms. Opposite deficits, i.e., the failure to attend and select stimuli, and to divide attention (i.e., hypoattention), represent a major variable in the development of dementia. The hypothesis that hyperattention and hypoattention are mediated via cortical cholinergic hyperactivity and hypoactivity, respectively, is discussed. Several lines of evidence support the role of cholinergic hyperactivity in the development of psychotic symptoms, including the therapeutic effects of anticholinergic drugs in schizophrenic patients, the psychotic effects of chronic exposure to irreversible cholinesterase inhibitors, and the worsening of psychotic symptoms as a result of the treatment with cholinomimetic compounds. The potent impairments of attentional abilities as a result of the administration of muscarinic antagonists in intact subjects, and the attentional effects of cholinomimetic compounds in demented patients are two examples of the evidence that supports the role of cholinergic hypofunction in the cognitive impairments of dementia. A neuronal model of dopamine-GABAergic modulation of cortical acetylcholine is proposed on the basis of evidence indicating that nucleus accumbens dopamine, via a GABAergic pathway to the substantia innominata of the basal forebrain, modulates cortical acetylcholine release. The available evidence confirms several predictions derived from this model, including the dopaminergic regulation of cortical acetylcholine (ACh) release, the bidirectional modulation of this release by benzodiazepine receptor (BZR) agonists and inverse agonists, and the antipsychotic effects of BZR agonists. Bidirectional deviations in the activity of cortical cholinergic inputs are hypothesized to represent a major neuronal substrate of the attentional dysfunctions associated with, or even underlying, the development of psychotic symptoms and dementia. The walk of a stranger on the street could be a sign to me which I must interpret. Every face in the windows of a passing streetcar would be engraved on my mind, all of them concentrating on me and trying to pass me some sort of message. McDonald N (1960) Living with schizophrenia. Can Med Assoc J 82:218–227 Today my mother did not recognize me. Dette U (1991) Ein langer Abschied. Der Verlauf einer Alzheimer-Krankheit. (A long farewell. A case of Alzheimer's disease). Fischer Taschenbuch, Frankfurt [in German]     

Coronary microcirculation: autoregulation and metabolic control

The majority of studies axamining the regulation of coronary blood flow and vascular resistance have considered the coronary circulation as being composed of large conduit vessels and resistance vessels. Recently, it has become apparent that regulation of coronary microvascular resistance is not distributed uniformly, but varies across different segments or microdomains of the vasculature. Generally, small arterioles, those less than 100 m in diameter, respond differently than larger arterioles and small arteries. There are major differences in the level of autoregulatory control, myogenic control, endothelial modulation and control by metabolic factors across these various microvascular domains. There are also transmural variations which may account for some of the differences in coronary blood observed between epicardial and endocardial regions. In addition, interactions between these various regulatory mechanisms further complicate the understanding of coronary microvascular regulation. Importantly however, it may be these complex interactions and heterogeneous regulatory mechanisms which allow for adequate perfusion of the myocardium under an extreme range of metabolic conditions. This segmental distribution of regulation suggests an integrative hypothesis of regulation whereby a variety of mechanisms play a role in the overall response.Invited Contributions to the Symposium Regulation of coronary blood flow, held at the XV. World Congress of the International Society for Heart Research in Prague 1995