bluuebunny/crossref_metadata_2025 huggingface dataset:
Effects of repetitive work on maintaining function in Alzheimer's disease patients
Authors: Bums Theressa , McCarten J. Riley , Adler Geri , Bauer Mary , Kuskowski Michael A.
Published: May 2006

The effects of repetitive work on Alzheimer ' disease (AD) patientfunctioning were examined when nine veterans were movedfrom a work program to a traditional adult day care program. Subjects were reassessedfour months after the move with the Mini-Mental State Examination (MMSE), Cognitive Performance Test (CPT), and Geriatric Depression Scale (GDS). Individual slopes were calculatedfor seven subjects who had longitudinal scores, and expected scores were predicted based on the rate ofdecline. Observed scores at reassessment were significantly lower than expected scores. The MMSE was on average 4.9 points lower, and the CPT. 64 points lower than expected. The GDS did not change. The spouses of all nine patients reported declines in daily living activities. Compared to traditional day care activities, work activities involve sequencing skills and practice may translate to self-care activities at home.
Mitochondrial alterations Alzheimer's disease
Authors: Baloyannis Stavros J. , Costa Vassiliki , Michmizos Demetrios
Published: May 2006

Morphological alterations of mitochondria may be related to metabolic and energy deficiency in neurons in Alzheimer's disease (AD) and other neurodegenerative disorders. In previous studies on the morphological and morphometric estimation of mitochondria in AD, electron microscopy revealed substantial morphological and morphometric changes in the hippocampus, the acoustic cortex, the frontal cortex, and the cerebellum. This study extends this observation to subcortical centers, namely the thalamus, the globus pallidus, the red nucleus, and the locus caeruleus in 10 brains of patients who suffered from AD. The morphological alterations consisted of very obvious changes of the mitochondrial cristae, accumulation of osmiophilic material and decrease of their size, in comparison with the normal controls. Mitochondrial alterations were particularly prominent in neurons, which showed loss of dendritic spines and abbreviation of the dendritic arborization. The ultrastructural study of a large number of neurons in the thalamus and the red nucleus revealed that the mitochondrial alterations did not coexist with cytoskeletal pathology and accumulation of amyloid deposits. However, they were prominent in neurons, which demonstrated fragmentation of the cisternae of the Golgi apparatus. The morphological alterations of the mitochondria presumably suggest oxidative damage in neurons in AD brains.
Tube feeding in advanced Alzheimer's disease: When language misleads
Authors: Lacey Debra
Published: May 2006

For much of the late 20th century, feeding tubes were often considered essential in the treatment of people with advanced Alzheimer's disease (AD) who developed swallowing or eating problems. Increasingly, the use of feeding tubes (i.e., percutaneous endoscopic gastrostomy or PEG tubes), has been challenged by empirical research, which has not supported the rationales provided for this intervention. The purpose of this commentary is to explain why healthcare providers, in light of empirical evidence, should refrain from using the terms “ lifesustaining” or “life-prolonging” when discussing tube feeding with older adults, their family members, or other surrogate decision-makers.
Barriers to the construction of a valued social identity: A case study of Alzheimer's disease
Authors: Sabat Steven R. , Napolitano Lisa , Fath Heather
Published: May 2006

This case study describes a person with mild-to-moderate stage Alzheimer's disease (AD) and examines the relationship between malignant positioning and the ability of a person with AD to gain the cooperation of healthy persons to construct a valued social identity. Findings reveal that malignant positioning limited the person with AD to the embarrassing social identity of dysfunctional patient; whereas, the absence of such positioning allowed the subject to gain the cooperation from others necessary to construct a valued social identity, as well as reduce embarrassment and experience greater sense of self-worth. Preliminary recommendations on reducing malignant positioning are provided. Further research is required to elucidate the degree to which the present findings may be generalized.
Significance of behavioural pathology on functional performance in individuals with Alzeimer's disease and related dementials
Authors: Cidboy Erin L.
Published: May 2006

Insight on the role of frontal systems functioning has led to the development of measures targeting behaviors mediated through the prefrontal cortex. The current review investigated the relationship of behavioral pathology to functional performance in individuals with dementia and discussed the association of behavioral pathology and executive dysfunction. Results indicated that both behavioral measures and cognitive status were strongly correlated to functional performance. However, neither behavioral measure nor cognitive status demonstrated a stronger association to functional performance at a greater consistency than the other measure. This review has important implications for the use of behavior measures by medical practitioners to determine the functional status of persons with Alzheimer's disease (AD) and other dementias and the use of results obtained by these measures to develop appropriate intervention strategies.
Differences in dementia services and settings across place type and regions
Authors: Weisman Gerald D. , Kovach Christine , Cashin Susan E.
Published: May 2006

People with dementia have complex and unique social, environmental, and communication needs arising from impaired cognition. One response to dissatisfaction with the medical model of care in nursing homes has been the creation of more homelike and social options for care in the community. These options include community-based residential facilities and a variety of more independent senior dwellings. Staying in residential settings longer may be associated with benefits, including decreased financial burden and improved quality of life.

However, with the boundaries between these place types often less than clearly drawn, it has become increasingly difficult to anticipate the specific services and environmental features provided by each. It is also difficult to effectively match facilities to the specific needs of older persons with dementia. Even social workers responsible for placements, especially in urban areas, may not be able to visit all local residential options. To better understand these new venues for dementia care, this study explored the range of services and settings available to people with dementia in three different place types in five Wisconsin counties: nursing homes, community-based residential facilities, and independent senior housing.
Lay person's recommendations about interventions for Alzheimer's disease: Correlates and relationship to help-seeking behavior
Authors: Werner Perla
Published: May 2006

The aim of this study was to examine lay persons' beliefs about the helpfulness of interventions for Alzheimer's disease (AD) and its correlates. Interviews were conducted with 206 Jewish Israeli adults (mean age 59.7), using an experimental vignette methodology varying in the severity of the disease. Information regarding participants' recommendations about the helpfulness of 10 interventions for the person described in the vignette was elicited. Sociodemographic and psychological correlates were examined.

We discovered that the lay public endorses the use of nonpharmacological treatments more than pharmacological ones. Engagement in social activities and participation in a support group were the treatment approaches most recommended, while the use of physical restraints and isolation were the least recommended. Beliefs about AD treatments were associated with helpseeking from professional sources.

Advances in the development of effective treatments for AD should be accompanied by research into the public's understanding of these treatments.
The emotional ramifications of unmet need in dementia caregiving
Authors: Gaugler Joseph E. , Anderson Keith A. , Leach Corinne R. , Smith Charles D. , Schmitt Frederick A. , Mendiondo Marta
Published: May 2006

Using a unique measure of unmet need that taps into several dimensions of informal long-term care, the present study included data from 694 informal caregivers of persons suffering from dementia at different times in the caregiving career (e.g., at home, following institutionalization, following the death of the care recipient). Multivariate regression models found that unmet need for either confidante or formal support had key implications for caregivers’ emotional distress in each of the care situations. The findings suggest that conceptual models should incorporate unmet need as a viable predictor of caregiving outcomes and that assessment of unmet need may provide guidance in the development of more refined psychosocial and community-based intervention protocols.
Synaptophysin immunoreactivity in Pick's disease: Comparison with Alzheimer's disease and dementia with Lewy bodies
Authors: Lippa Carol F.
Published: May 2006

Frontotemporal lobe atrophy is a hallmark of Pick's disease (PiD), however, the underlying pathobiology of the neuronal losses is unknown. Synaptic losses have been described in Alzheimer's disease (AD) and correlate with the severity of dementia, however, few studies of synaptic integrity have been done to determine whether synaptic loss also contributes to symptoms in non-AD dementias. To begin to assess synaptic integrity in other types of dementia, we examined the site of termination of the hippocampal perforant pathway, the major source of afferent tracts to the hippocampus. We determined immunoreactivity for the synaptic-terminal specific protein synaptophysin in the outer molecular layer of the hippocampal dentate gyrus (OMDG) in eight PiD, nine AD, nine dementia with Lewy bodies (DLB), and seven control cases. Quantitative data were obtained using an Image-Pro automated image analysis system. In AD and PiD, synaptophysin immunoreactivity was visibly reduced in the OMDG. Densitometric analysis confirmed that there were statistically significant differences among groups in synaptophysin immunoreactivity when comparing the OMDG to the adjacent inner molecular layer of the hippocampal dentate gyrus (IMDG) (p = 0.002). These differences were present between PiD and both the control and DLB groups. The AD group also showed a reduction in synaptophysin immunoreactivity compared with DLB and control groups. In contrast, perforant pathway synaptic losses in DLB were minimal. Our data supports the hypothesis that focal synaptic losses occur in PiD and AD and may contribute to the cognitive deficits in both conditions.
Cholinesterase inhibition as a possible therapy for delirium in vascular dementia: A controlled, open 24-month study of 246 patients
Authors: Moretti Rita , Torre Paola , Antonello Rodolfo M. , Cattaruzza Tatiana , Cazzato Giuseppe
Published: May 2006

The goal of this study was to determine whether rivastigmine, a dual inhibitor of acetylcholinesterase (AChE) and butyrylcholinesterase (BuChE), has any effect on delirium in vascular dementia (VaD). The results from this follow-up study suggest that although delirium is frequent in elderly, cognitively impaired patients, it might not be a simple consequence of acute disease and hospitalization. Rather, delirium can be secondary to brain damage and to metabolic disturbances. According to the Lewy body dementia model, delirium could be induced by a lack of acetylcholine in the brain. Rivastigmine may help reduce the frequency of delirium episodes and help shorten their duration. Additional studies are required to better define the causes of delirium, which currently has no definitive treatment.
Development of the Knowledge about Memory Loss and Care (KAML-C) test
Authors: Kuhn Daniel , King Scott P. , Fulton Bradley R.
Published: May 2006

The purpose of this study was to develop a test to assess the knowledge of family caregivers concerning memory loss, the early stages of Alzheimer's disease (AD), and related care issues. A total of 31 multiple-choice items were generated in three domains: medical information, caregiving, and legal/financial planning. The test was administered to experts in the field of dementia research and care, medical students, and family caregivers. Item analysis procedures were then used to reduce the test to 15 items. Results suggest that the Knowledge about Memory Loss and Care (KAML-C) test is a reliable and valid test for examining the knowledge level of family caregivers with a relative in the early stages of dementia.
Treatment of chronic pain in persons with dementia: An overview
Authors: Rubey Robert N.
Published: May 2006

The purpose of this review is to identify the common causes of nonmalignant chronic pain in people with dementia, discuss methods for determining the level of pain in patients who are nonverbal, and evaluate pharmacologic treatment for nonmalignant chronic pain.
Memantine: Targeting glutamate excitotoxicity in Alzheimer's disease and other dementias
Authors: Molinuevo José L. , Lladó Albert , Rami Lorena
Published: May 2006

The management of dementia has changed since the development of new antidementia drugs. The benefits observed in Alzheimer's disease (AD) with selective cholinergic transmission treatments are mainly symptomatic, without clear evidence of neuroprotection. The hypothesis that glutamate-mediated neurotoxicity is involved in the pathogenesis of AD is finding increasingly more acceptance in the scientific community. Glutamate receptors are overactive, and N-methyl-Daspartate (NMDA) receptor antagonists have therapeutic potential for the treatment of AD and other neurological disorders. Memantine is a noncompetitive NMDA antagonist that is considered a neuroprotective drug. Memantine's capacity has been demonstrated in preclinical studies, and it is considered a useful symptomatic treatment for AD. Memantine has been shown to benefit cognition, function, and global outcome in patients with moderate to severe AD, and it is currently approved by the US Food and Drug Administration (FDA) for the treatment of moderate to severe AD. Recently, memantine has also demonstrated efficacy in the initial stages of AD, although FDA authorization is pending. This review highlights the important pharmacological and clinical aspects of memantine, as well as some basic mechanisms mediating glutamatergic neurodegeneration.
Evidence that immunoglobulin-positive neurons in Alzheimer's disease are dying via the classical antibody-dependent complement pathway
Authors: D'Andrea Michael R.
Published: May 2006

A recent study provided evidence that immunoglobulins (Igs) are not only present in Alzheimer's disease (AD) brains, but are also immunohistochemically detected in and/or on a particular population of pyramidal neurons that appeared morphologically degenerative in contrast to neighboring normal-appearing Ig-negative neurons.1 Because little has been reported about these Ig-positive neurons, the objectives of this study were to characterize the inflammatory profile of these neurons in the AD brain by determining if they possess complement components and are associated with reactive microglia. The data showed that the Ig-positive neurons had complement C1q and C5b-9 proteins and appeared degenerative. Furthermore, D-related human leukocyte antigen (HLA-DR)–positive fibers of reactive microglia were spatially closer (p < 0.001) and often in contact with the Ig-positive neurons than the Ig-negative neurons. Collectively, these data suggest that the Ig-positive neurons detected in AD brains are dying from the processes of the antibody-induced classical complement pathway.
Electroencephalogram in the dementia workup
Authors: Jenssen Sigmund
Published: May 2006

Dementia is affecting an increasing proportion of the population in the developed world. It is important to reach a correct diagnosis of dementia, because this has implications on the treatment. The electroencephalogram (EEG) is, in general, not a sensitive test for detecting dementia and is not recommended in the standard workup of dementia. In spite of this, however, EEG is useful in patients with deteriorating mental status in whom dementia is suspected mainly to rule out delirium, depression, atypical complex partial seizures, and prion disease. An EEG also provides insight into the physiology of different dementia types. The EEG is most useful when interpreted within a well-defined clinical context, such as knowing the patient's degree of cognitive impairment. It is a noninvasive and inexpensive test, and the threshold should be low for ordering it. This article summarizes EEG findings with aging, different dementia types, and conditions masked as dementia.
Assessment of everyday behavior in Alzheimer's disease patients: Its significance for diagnostics and prediction of disease progression
Authors: Bläsi Stefan , Brubacher Dorothee , Zehnder Antoinette E. , Monsch Andreas U. , Berres Manfred , Spiegel René
Published: May 2006

In addition to cognitive decline, current diagnostic criteria for Alzheimer's disease (AD) require evidence of impaired social and/or occupational functioning. The Nurses' Observation Scale for Geriatric Patients (NOSGER) is used to rate the frequency of disturbances in everyday behaviors and, although not specifically developed for this purpose, is often applied for diagnostic purposes. The NOSGER assesses six dimensions: Memory, Instrumental Activities of Daily Living (IADLs), Self-Care (ADL), Mood, Social Behavior, and Disturbing Behavior.

The goals of this study were 1) to establish normative data for the NOSGER as a function of demographic variables (i.e., age, years of education, and gender) in healthy elderly subjects; 2) to obtain cutoff values distinguishing healthy elderly subjects from probable AD patients with mild dementia; and 3) to describe the natural course of behavioral changes occurring in mild AD according to the NOSGER dimensions.

NOSGER data of 445 normal controls [NCs, 376 men, 69 women; Mini-Mental Status Examination (MMSE) = 28.8 ± 1.17] and 217 probable AD patients with mild dementia (97 men, 120 women; MMSE = 26.1 ± 1.59) from the Memory Clinic of Basel, Switzerland, were analyzed.

Cutoff scores for distinguishing between average NCs and mildly demented AD patients ranged between 7 and 9 for different NOSGER dimensions. Formulae to obtain demographically adjusted and z-transformed NOSGER dimension and MMSE scores for assessment of individual cases were determined. NCs were best distinguished from patients in the NOSGER dimension Mood, followed by Memory, ADLs, Social Behavior, and Disturbing Behavior. Linear courses of behavioral deterioration were found in four NOSGER dimensions (Memory, IADLs, Mood, and Social Behavior) in these mildly demented patients. No quadratic course was found for any of the NOSGER dimensions.

The NOSGER revealed good discriminatory power in those behavioral dimensions affected in early stages of AD and is suitable for monitoring behavioral changes as a function of disease progression. Its use in combination with the MMSE for dementia screening purposes is recommended.
Disclosure of diagnosis of Alzheimer's disease in French genral practice
Authors: Cantegreil-Kallen Inge , Turbelin Clément , Olaya Emile , Blanchon Thierry , Moulin Florence , Rigaud Anne-Sophie , Flahault Antoine
Published: May 2006

Most practitioners find disclosing the diagnosis of Alzheimer's disease (AD) to an individual with dementia very difficult. Literature results show a wide variability in attitudes and clinical practice, and diagnosis seems to be more often disclosed to caregivers than to patients. The objective of this study was to examine whether and how diagnosis of AD is disclosed in French general practice and which issues are addressed with the patient.

A questionnaire was sent via mail to 1,629 general practitioners (GPs), 1,105 belonging to the Sentinel's network and 524 specially recruited doctors practicing in the Rhône-Alpes region.

A total of 631 questionnaires were returned (response rate, 39 percent), of which 616 were eligible for analysis. Twenty-eight percent of GPs reported having disclosed the diagnosis to the patient (25 percent mentioned “Alzheimer's disease”), whereas 88 percent considered it their role to announce the diagnosis to the patient. Regarding the type of information provided to the patient, only 25 percent discussed the nature of the illness, 23 percent behavioral problems, and 47 percent depression, mainly for psychological reasons (63 percent). Stress was discussed with 79 percent of the caregivers.

We concluded that GPs do not discuss the consequences of AD and symptoms (e.g., behavioral disorders) with patients, mainly for psychological reasons, whereas they have a less-reluctant attitude toward caregivers. As the GP has the weighty task of providing appropriate community care and psychological support to the patient, it is of utmost importance to reflect on how disclosure of diagnosis can be facilitated.
Alzheimer's disease behaviors from past self-identities: An exploration of the memory and cognitive features
Authors: Harrison Barbara E. , Therrien Barbara A. , Giordani Bruno J.
Published: May 2006

Alzheimer's disease (AD) patients have been reported by caregivers to display “behaviors from past self-identities” (BPSI); however, there is little known about these distinct behaviors. This study, the first to explore BPSI, hypothesized that BPSI were associated with self-memory and cognitive impairments. Its purpose was to determine if AD subjects with and without BPSI differed on measures of autobiographical memory, selective attention, and fluency. The cross-sectional design compared 35 moderatestage AD subjects from an AD research center. Subjects demonstrating BPSI (37 percent) recalled significantly fewer recent autobiographical memories than AD subjects without BPSI. The results establish BPSI as a common behavior among moderate-stage AD patients and suggest that paucity of recent self-memories contributes to BPSI.
Tube feeding, antibiotics, and hospitalization of nursing home residents with end-stage dementia: Perceptions of key medical decision-makers
Authors: Lacey Debra
Published: May 2006

This article discusses the literature supporting the limited use of tube feeding, antibiotics, and hospital transfers of nursing home residents with end-stage dementia. This article also presents the findings of a study that queried 138 nursing home social service staff members in New York State regarding positions taken by key medical decision makers regarding tube feeding, antibiotic use, and hospitalization of nursing home residents with end-stage dementia. Results are discussed in the context of positions taken by experts in palliative and dementia care. According to social service staff perceptions, the majority of these key decision-makers (e.g., administrators, directors of nursing, and medical directors) take positions inconsistent with palliative care experts. Instead, a majority of them were perceived as more likely to encourage tube feeding, antibiotics, and hospitalization of nursing home residents with end-stage dementia. These findings indicate a strong need for educating administrative staff in state-of-the-art care of residents with end-stage dementia.
Emotional reactions to predictive testing in Alzheimer's disease and other inherited dementias
Authors: Molinuevo José L. , Pintor Luis , Peri Josep Mª , Lleó Alberto , Oliva Rafael , Marcos Teodor , Blesa Rafael
Published: May 2006

This work describes the reasons and emotional responses of healthy descendants after counseling for presenilin mutations in early-onset familial Alzheimer's disease (EOFAD), tau mutations in familial frontotemporal dementia (FTD), and prion mutations in fatal familial insomnia (FFI).

A multidisciplinary protocol following Huntington's disease counseling guidelines and a post-test follow-up program were developed to counsel healthy descendants of affected families. The psychological consequences, anxiety levels, and depression status were assessed through validated scales before and after disclosing the information.

Nine people from three different families, one with EOFAD, another with FTD, and the other with FFI came for counseling. Their main reason for testing was to initiate early treatment in the future. Disclosing the information decreased anxiety in two carriers, increased it temporarily in one, and had no effect in another. All noncarriers felt relieved. Overall, after a mean of 30 months of follow-up, no negative psychological reactions were observed. All participants positively valued the program.

Although preliminary, our observations suggest that predictive testing in EOFAD, FTD, and FFI is safe and may be of benefit when performed with a delicate approach under strict pretest counseling protocols and post-test follow-up programs. The emotional reactions were similar, although the diseases, their phenotype, and mutation characteristics were different.
Subjective appraisal of Alzheimer's disease caregiving: The role of self-efficacy and depressive symptoms in the experience of burden
Authors: Gonyea Judith G. , O’Connor Maureen , Carruth Anastasia , Boyle Patricia A.
Published: May 2006

Most studies investigating correlates of Alzheimer's disease (AD) caregiver burden have focused on the role of objective factors as opposed to subjective factors. Although objective variables (e.g., caregiver age, patient dementia severity, functional status) have been shown to be significantly associated with burden, the correlations generally are modest and explain relatively little of the variability in caregiver outcomes. Moreover, many of these objective variables are not modifiable and are of limited use in the development of caregiver interventions. Thus, there continues to be a need to identify powerful and modifiable determinants of caregiver burden. This study examined the role of two subjective factors—self-efficacy and depressive symptoms—as predictors of AD caregiver burden. Based on a sample of 80 AD caregivers, hierarchical regression analyses revealed that self-efficacy and depressive symptoms each had a significant independent effect on the experience of burden even after accounting for objective factors. These findings suggest that caregiver interventions aimed to reduce burden may benefit from the incorporation of specific strategies to increase self-efficacy and decrease depressive symptoms.
Perceptions of family caregivers’ psychosocial behavior when communicating with spouses who have Alzheimer's disease
Authors: Small Jeff A. , Perry JoAnn , Lewis Julie
Published: May 2006

The literature for caregivers of persons with Alzheimer 's disease (AD) notes the importance of attending to the linguistic and psychosocial dimensions of communication. The objective of this study was to investigate the relationship between psychosocial aspects of caregivers’ behavior and communication outcomes for persons with AD and their spousal caregivers. In the first part of the study, we selected 40 segments of audio-recorded conversations between persons with AD and their spouses. We then asked 20 healthy seniors who were not caregivers to listen to and read the conversation segments and evaluate each segment along four psychosocial dimensions. They were also asked to independently rate how smooth the communication was in each segment. We hypothesized that when caregivers’ speech is perceived to be respectful, caring, not controlling, and/or it ascribes competence to their spouses, it would be associated with more effective communication. Our results supported these hypotheses in that communication was more likely to be rated higher in smoothness when the content and manner of caregivers’ speech were perceived to have positive psychosocial qualities. The findings have implications for training caregivers on effective psychosocial behavior when interacting with persons who have AD.
Using cognitive mapping to explore women caregivers' experiences
Authors: Valentino Carmela Cassisi , Bulmer Sandra Minor
Published: May 2006

Women are often faced with the primary role of providing care for individuals with Alzheimer's disease (AD). This study explored women caregiver's perceptions of caregiving through the use of Cognitive Mapping (CM), a qualitative research method. Volunteers were recruited from caregiver support groups to construct maps of their experience of “caregiving for someone with AD.” Maps were analyzed for commonly identified concepts and relationships. Twelve participants identified 280 concepts, 206 of which were unduplicated. Concepts were collapsed into 17 categories; the largest concepts being “friends and family,” “sad,” “frustration,” and “time.” The maps produced by the sample in this study were unique, providing evidence that the experience of AD caregiving varies significantly among caregivers. CM appears to be effective for identifying caregiver stressors and needed support services.
Vulnerable populations at risk of potentially avoidable hospitalizations: The case of nursing home residents with Alzheimer's disease
Authors: Carter Mary W. , Porell Frank W.
Published: May 2006

This study explores whether nursing home residents with Alzheimer's disease and related dementias (ADRD) are affected differently by facility-level risk factors of ambulatory care-sensitive (ACS) conditions, a measure of timely access to medical care. Three years of quarterly Medicaid reimbursement data from over 525 Massachusetts nursing homes were linked with four years of Medical Provider Analysis and Review hospital claims data and facility-level attribute data to investigate whether facility effects differed by resident ADRD status. The findings suggest that nursing home residents with ADRD are more likely to be hospitalized for certain ACS conditions, including gastroenteritis and kidney/urinary tract infections. Availability of increased registered nurse staffing levels and on-site nurse practitioners appears to attenuate this risk. Although findings suggest that ACS hospitalization measures may represent a useful approach to monitoring nursing home care, additional effort is needed to understand the extent to which severity of illness and/or comorbidities affect the measurement of these hospitalizations.
Genetic susceptibility for Alzheimer's disease: Why did adult offspring seek testing?
Authors: Hurley Ann C. , Harvey Rose , Roberts J. Scott , Wilson-Chase Chantel , Lloyd Stephanie , Prest Janalyn , Lock Margaret , Horvath Kathy J. , Green Robert C.
Published: May 2006

This study explored why adult offspring of individuals with Alzheimer's disease (AD) sought genetic susceptibility testing for AD. Participants (N = 60) were a subset of subjects from the first randomized controlled clinical trial to offer such testing. Qualitative analysis revealed two central constructs: altruism and learning. Planning for the future, hoping to prevent AD, and need to know were concepts that explained the value of learning. These results add important contextual information into why people might seek information on their genetic risk for a severe neurodegenerative disease for which there are, as yet, no preventative treatments. As genetic susceptibility testing for numerous other diseases enters clinical medicine, these findings can enhance the knowledge and sensitivity of researchers and clinicians when they are asked by participants or patients whether they should be tested.
Factors that relate to activity engagement in nursing home residents
Authors: Kolanowski Ann , Buettner Linda , Litaker Mark , Yu Fang
Published: May 2006

Many nursing home residents are unoccupied and at risk for poor health outcomes because of inactivity. The purpose of this study was to identify characteristics of residents with dementia that predict engagement in activities when activities are implemented under ideal conditions. Data from a clinical trial that tested the efficacy of individually prescribed activities were used to address the study aim. Thirty subjects were videotaped daily for 12 days during 20-minute activity sessions. Measures of engagement (time on task and level of participation) were taken from these videotapes. Univariate logistic regression analyses indicated that cognitive status and physical function explained a significant amount of variance in engagement. Efforts to promote function may facilitate even greater benefits from prescribed activities by improving capacity for engagement.
Prognostic Factors of Leg Amputation in Patients With Vascular Injury: A Systematic Review
Authors: Rerkasem K. , Arworn S. , Thepmalai K.
Published: May 2006

Individual studies on the prognostic factors of leg amputation, due to vascular injury, have been small, and they have produced conflicting results. Reliable data are necessary so that surgery can be targeted more effectively. The authors carried out a systematic review from 1990 to 2002 to identify the high risk of patients to amputation. Meta-analysis was carried out. The authors found that patients with preoperative hypotension, popliteal artery injury, and associated bone and nerve injury had a significantly higher risk of leg amputation than those without these risk factors. Also, patients with postoperative infection had a higher chance of amputation than those without infection. This information is essential for an appropriate evaluation and the treatment of such patients.
Diagnostic Criteria and Treatment of Buerger’s Disease: A Review
Authors: Lazarides M. K. , Georgiadis G. S. , Papas T. T. , Nikolopoulos E. S.
Published: May 2006

Buerger’s disease is an inflammatory occlusive disorder affecting the small and medium-size arteries and veins of young, predominately male, smokers. The disorder has been identified as an autoimmune response triggered when nicotine is present. Tobacco abuse is the major contributing risk factor; however, smoking seems to be a synergistic factor rather than the cause of the disease. The traditional diagnosis of Buerger’s disease is based on 5 criteria (smoking history, onset before the age of 50 years, infrapopliteal arterial occlusive disease, either upper limb involvement or phlebitis migrans, and absence of atherosclerotic risk factors other than smoking). As there is no specific diagnostic test and an absence of positive serologic markers, confident clinical diagnosis should be made only when all these 5 criteria have been fulfilled although not universally accepted. The angiographic findings in Buerger’s disease (“corkscrew,” “spider legs,” or “tree roots”) are helpful but not pathognomonic. A wide spectrum of medical or surgical therapeutic options have been proposed; however, total abstinence from tobacco use remains the only means of stopping the disease progression. The initial management of patients with Buerger’s disease should be conservative. Because several arteries may be unaffected, claudicants should be encouraged to walk, whereas patients with “critical” ischemia should be admitted for bed rest in the hospital. Bypass grafting is seldom an option, as the location of the lesions distally leaves little to bypass because of lack of target vessels. A literature review revealed only a few series reporting vascular reconstruction (mainly femorodistal bypasses) in Buerger’s disease. Bypass patency rates were suboptimal; however, the corresponding limb salvage rates were satisfactory. A possible explanation is that patent grafts, even over a short period of time, are sufficient to allow healing of ulcers in patients with Buerger’s disease.
Evaluation of the Antibacterial Activity and Toxicity of 2 New Hydrogels: A Pilot Study
Authors: Vandenbulcke Katia , Horvat Lada-Ivana Laenen , De Mil Martine , Slegers Guido , Beele Hilde
Published: May 2006

Wound bed preparation remains a very important issue in wound healing. To promote the production of granulation tissue, it is necessary to remove necrotic tissue and to control infection. Necrotic tissue may be removed using a hydrogel preparation. Flaminal ® and Flaminal ® Hydro (Flen Pharma, Belgium) are 2 new hydroactive colloid gel dressings with state antibacterial properties. These properties are attributed to an enzymatic complex in their formulation. In the study described in this report, the antibacterial effects of Flaminal and Flaminal Hydro were confirmed in an in vitro as well as an in vivo setting. It was also demonstrated that Flaminal and Flaminal Hydro are not toxic to keratinocytes in vitro using an MTT [3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide] test.
Predictive factors for thrombosis and major bleeding in an observational study in 181 patients with heparin-induced thrombocytopenia treated with lepirudin
Authors: Tardy Bernard , Lecompte Thomas , Boelhen Françoise , Tardy-Poncet Brigitte , Elalamy Ismaïl , Morange Pierre , Gruel Yves , Wolf Martine , François Dominique , Racadot Evelyne , Camarasa Philippe , Blouch Marie Thérèse , Nguyen Françoise , Doubine Sylvie , Dutrillaux Fabienne , Alhenc-Gelas Martine , Martin-Toutain Isabelle , Bauters Anne , Ffrench Patrick , de Maistre Emmanuel , Grunebaum Lélia , Mouton Christine , Huisse Marie G. , Gouault-Heilmann Michèle , Lucke Veronique ,   for the GEHT-HIT study group
Published: May 2006

The antithrombotic efficacy of lepirudin in patients with heparin-induced thrombocytopenia (HIT) is compromised by an increased risk for bleeding. A retrospective observational analysis in 181 patients (median age, 67 years) with confirmed HIT treated in routine practice with lepirudin was performed to identify predictive factors for thrombotic and bleeding complications. Lepirudin was administered at a mean (± SD) dose of 0.06 ± 0.04 mg/kg/h (compared with a recommended initial dose of 0.15 mg/kg/h). Mean activated partial thromboplastin time was greater than 1.5 times baseline value in 99.4% of patients. Median treatment duration was 7.7 days. Until discharge from the hospital, 13.8% and 20.4% of patients experienced a thrombotic or a major bleeding event, respectively. On multivariate analysis, mean lepirudin dose was not a significant predictive factor for thrombosis. In contrast, mean lepirudin dose greater than 0.07 mg/kg/h, long duration of lepirudin treatment, and moderate to severe renal impairment were significant positive factors for major bleeding. Overall, these results suggest that the recommended dose of lepirudin in patients with HIT is too high; the use of reduced doses may be safer with regard to bleeding risk and does not compromise antithrombotic efficacy.
Apoptotic cells promote macrophage survival by releasing the antiapoptotic mediator sphingosine-1-phosphate
Authors: Weigert Andreas , Johann Axel M. , von Knethen Andreas , Schmidt Helmut , Geisslinger Gerd , Brüne Bernhard
Published: May 2006

Programmed cell death is vital for a number of pathophysiologic settings. Apoptotic cells are rapidly engulfed by phagocytes (ie, macrophages), which in turn acquire an anti-inflammatory phenotype known as alternative activation or the M2-type. Here we show that interaction of apoptotic cells with macrophages attenuates cell death pathways in the latter. Protection of human macrophages required phosphoinositide 3-kinase (PI3K), extracellular signal-regulated kinase 1/2 (ERK1/2), and Ca2+ signaling, and correlated with Bcl-XL and Bcl-2 up-regulation as well as Ser136-Bad phosphorylation. Unexpectedly, neither phagocytosis nor binding of apoptotic debris to the phagocyte was necessary to induce protection. Surprisingly, apoptotic cells released sphingosine-1-phosphate (S1P), mainly derived from sphingosine kinase 2, as a survival messenger. This points to an active role of apoptotic cells in preventing cell destruction in their neighborhood, with implications for innate immunity and inflammation.
Platelet-derived growth factor receptor-β promotes early endothelial cell differentiation
Authors: Rolny Charlotte , Nilsson Ingrid , Magnusson Peetra , Armulik Annika , Jakobsson Lars , Wentzel Parri , Lindblom Per , Norlin Jenny , Betsholtz Christer , Heuchel Rainer , Welsh Michael , Claesson-Welsh Lena
Published: May 2006

Platelet-derived growth factor BB (PDGF-BB) has been assigned a critical role in vascular stability by promoting the recruitment of PDGF receptor-β–expressing perivascular cells. Here we present data indicating that early hematopoietic/endothelial (hemangio) precursors express PDGFR-β based on coexpression with CD31, vascular endothelial growth factor receptor-2, and CD41 in 2 models: mouse yolk sac (embryonic day 8 [E8]) and differentiating mouse embryonic stem cells (embryoid bodies). Expression of PDGFR-β on hemangioprecursor cells in the embryoid bodies gradually disappeared, and, at E14, expression appeared on perivascular cells. Activation of the PDGFR-β on the hemangioprecursors accelerated the differentiation of endothelial cells, whereas differentiation of the hematopoietic lineage was suppressed. In E9.5 yolk sacs derived from recombinant mice expressing kinase-active PDGFR-β with an aspartic acid to asparagine (D894N) replacement in the kinase activating loop and from mice with ubiquitous expression of PDGF-BB driven by the Rosa26 locus, the number of CD41-expressing early hematopoietic cells decreased by 36% and 34%, respectively, compared with staged wild-type littermates. Moreover, enhanced vascular remodeling was evident in the Rosa26–PDGF-BB yolk sacs. We conclude that PDGFR-β is expressed on early hemangioprecursor cells, regulating vascular/hematopoietic development.
Expression of eicosanoid receptors subtypes and eosinophilic inflammation: implication on chronic rhinosinusitis
Authors: Pérez-Novo Claudina Angela , Claeys Cindy , Van Cauwenberge Paul , Bachert Claus
Published: May 2006

Background

Eicosanoid receptors are G-protein-coupled receptors playing an important immunomodulatory role in airway diseases. However, there is little information on the expression of these receptors and their link with eosinophilic inflammation in paranasal sinus diseases. We aimed with this study to investigate the tissue expression of leukotrienes and prostaglandin E2 receptors in chronic rhinosinusitis patients and the link of this regulation with eosinophilic inflammation.

Methods

Samples were prepared from nasal tissue of patients with chronic rhinosinusitis without nasal polyps (CRS, n = 11), with nasal polyps (CRS-NP, n = 13) and healthy subjects (Controls, n = 6). mRNA expression of CysLT1, CysLT2, BLT1, BLT2, E-prostanoid receptors (EP1, EP2, EP3, EP4) and sol-IL-5Rα was determined by real-time PCR. Concentrations of PGE2, LTC4/D4/E4, LTB4 and sol-IL-5Rα were determined by ELISA and of ECP by ImmunoCap. Protein expression and tissue localization of eicosanoid receptors and activated eosinophils were evaluated by immunohistochemistry.

Results

CysLT1 mRNA expression was significantly increased in CRS-NP compared to CRS and controls, and CRS compared to controls, whereas CysLT2 mRNA was enhanced in both CRS groups without differences between them. Levels of both receptors correlated to the number of activated eosinophils, sol-IL-5Rα, ECP and LTC4/D4/E4 concentrations in the disease groups. PGE2 protein concentrations and prostanoid receptors EP1 and EP3 were down-regulated in the CRS-NP tissue vs. CRS and controls, whereas EP2 and EP4 expression was enhanced in CRS and CRS-NP patients vs. controls. No differences in BLT receptors were observed between patients and controls.

Conclusion

CyLTs receptors are up-regulated in nasal polyp tissue and their expression correlate with eosinophilic inflammation supporting previous results. Eicosanoid receptors mRNA pattern observed suggests that down-regulation of EP1 and EP3 in CRS-NP and up-regulation EP2 and EP4 in CRS and CRS-NP groups may have some role in the development of the diseases and their regulation may not be directly linked to eosinophil activation but involve post-transcriptional events mainly related to other inflammatory cell sources.
Energized, Polarized, and Actively Respiring Mitochondria Are Required for Acute Leydig Cell Steroidogenesis
Authors: Allen John A. , Shankara Tristan , Janus Paul , Buck Steve , Diemer Thorsten , Held Hales Karen , Hales Dale B.
Published: May 2006

The first and rate-limiting step in the biosynthesis of steroid hormones is the transfer of cholesterol into mitochondria, which is facilitated by the steroidogenic acute regulatory (StAR) protein. Recent study of Leydig cell function has focused on the mechanisms regulating steroidogenesis; however, few investigations have examined the importance of mitochondria in this process. The purpose of this investigation was to determine which aspects of mitochondrial function are necessary for acute cAMP-stimulated Leydig cell steroidogenesis. MA-10 cells were treated with 8-bromoadenosine 3′,5′-cyclic monophosphate (cAMP) and different site-specific agents that disrupt mitochondrial function, and the effects on acute cAMP-stimulated progesterone synthesis, StAR mRNA and protein, mitochondrial membrane potential (Δψm), and ATP synthesis were determined. cAMP treatment of MA-10 cells resulted in significant increases in both cellular respiration and Δψm. Dissipating Δψm with carbonyl cyanide m-chlorophenyl hydrazone resulted in a profound reduction in progesterone synthesis, even in the presence of newly synthesized StAR protein. Preventing electron transport in mitochondria with antimycin A significantly reduced cellular ATP, potently inhibited steroidogenesis, and reduced StAR protein levels. Inhibiting mitochondrial ATP synthesis with oligomycin reduced cellular ATP, inhibited progesterone synthesis and StAR protein, but had no effect on Δψm. Disruption of intramitochondrial pH with nigericin significantly reduced progesterone production and StAR protein but had minimal effects on Δψm. 22(R)-hydroxycholesterol-stimulated progesterone synthesis was not inhibited by any of the mitochondrial reagents, indicating that neither P450 side-chain cleavage nor 3β-hydroxysteroid dehydrogenase activity was inhibited. These results indicate that Δψm, mitochondrial ATP synthesis, and mitochondrial pH are all required for acute steroid biosynthesis. These results suggest that mitochondria must be energized, polarized, and actively respiring to support Leydig cell steroidogenesis, and alterations in the state of mitochondria may be involved in regulating steroid biosynthesis.
Sol–Gel Process of Oxides Accompanied by Phase Separation
Authors: Nakanishi Kazuki
Published: May 2006

A versatile sol–gel method for fabricating porous oxide materials with well-defined co-continuous macropores has been reviewed. The chemical instability, in many cases induced by polymerization of the network-forming components, triggers the formation of biphasic morphologies, followed by an irreversible freezing of the transient morphology by the sol–gel transition of the gelling phase. Upon removal of the non-gelling phase, an oxide framework comprising of controlled macropores can be obtained. The mesopore system of such macroporous materials can be further modified either by a physico-chemical treatment or a supramolecular templating technique. Pure silica and siloxane-based organic–inorganic hybrids with a hierarchical pore system in monolithic form have been successfully applied to the novel type of separation medium for high performance liquid chromatography, HPLC. Additional topics are also described including recent advances in the 3D-analysis of the interfacial properties of macroporous systems, extended compositional variations in the network-forming phase, and emerging applications in areas of biochemistry.
Isomerism of Assembled Iron Complex Bridged by 1,2-Di(4-pyridyl)ethane and Its Solid-to-Solid Transformation Accompanied by a Change of Electronic State
Authors: Morita Takaki , Asada Yoritaka , Okuda Tsutomu , Nakashima Satoru
Published: May 2006

Three supramolecular isomers of an Fe–NCS complex and two isomers of an Fe–NCSe complex bridged by 1,2-di(4-pyridyl)ethane have been obtained. 57Fe Mössbauer spectroscopy revealed a drastic change in the QS value by changing the structure and by changing NCS to NCSe. Solid-to-solid transformation was observed, accompanied by a drastic change in the QS value.