Use of statins and incidence of dementia and cognitive impairment without dementia in a cohort study

OBJECTIVE

Evidence of a relation between use of lipid lowering drugs and cognitive outcomes is mixed. This study aimed to test the association between use of statins and incidence of dementia and cognitive impairment without dementia (CIND) over 5 years of follow-up.

METHODS

Data were from a population-based cohort study comprising 1,789 older Mexican Americans. All participants had cognitive and clinical evaluations performed every 12 to 15 months. Participants who fell below specified cutpoints on cognitive tests were then evaluated clinically. Dementia diagnoses were finalized by an adjudication team. A total of 1,674 participants free of dementia/CIND at baseline were included in these analyses. Statin use was verified at each participant's home by medicine cabinet inspection. Cox proportional hazards models were used to evaluate the association between statin use and incidence of dementia/CIND.

RESULTS

Overall, 452 of 1,674 participants (27%) took statins at any time during the study. Over the 5-year follow-up period, 130 participants developed dementia/CIND. In Cox proportional hazards models adjusted for education, smoking status, presence of at least one APOE epsilon4 allele, and history of stroke or diabetes at baseline, persons who had used statins were about half as likely as those who did not use statins to develop dementia/CIND (HR = 0.52; 95% CI 0.34, 0.80).

CONCLUSION

Statin users were less likely to have incident dementia/cognitive impairment without dementia during a 5-year follow-up. These results add to the emerging evidence suggesting a protective effect of statin use on cognitive outcomes.

Direct correlation between nonrandom ion hopping and network structure in ion-conducting borophosphate glasses

We present temperature-dependent conductivity spectra of sodium borophosphate glasses with a varying borate/phosphate ratio but a constant sodium oxide content which can be mapped into time-dependent mean square displacements. For the first time, we show that characteristic lengths of ion transport derived thereof are directly linked to features of network structure, viz., the number of boron oxide tetrahedra. Our results also shed light on the mixed network former effect.

Allergic sensitization and disease in mother-child pairs from Germany: role of early childhood environment

BACKGROUND

Early childhood influences are important for the development of the allergic phenotype. In East Germany, tremendous lifestyle changes took place after 1990 and it can be hypothesized that the allergic phenotypes in mothers and their children are less similar than in West Germany. This was investigated in our study done in mothers and their 6-year-old children from East and West Germany in the year 2000.

METHODS

1,393 mother-child pairs participated. A subgroup of 774 pairs gave blood for the determination of specific IgE. Regional differences in mother-child correlations and in prevalence of mother-child combinations with respect to allergic sensitization and disease were examined by logistic regression analysis.

RESULTS

The adjusted association in positive allergic sensitization between mothers and their children was not significant in East Germany (OR 1.23, 95% CI: 0.68-2.24) but highly significant in West Germany (OR 2.89, 95% CI: 1.73-4.80). The probability for the combination of 'negative' mother and 'positive' child was significantly higher in East than in West Germany.

CONCLUSIONS

Mother-child transmission of atopy predisposition can even be cancelled by environmental changes.

Prognostic relevance of p53 and bcl-2 immunoreactivity for early invasive pT1/pT2 gastric carcinomas: indicators for limited gastric resections?

BACKGROUND

Laparoscopic or endoscopic limited resection is intended to be an additional therapeutic option for the treatment of early gastric cancer. However, tumorbiologic markers to predict the outcome for patients after limited resections are missing. This study therefore investigated the prognostic relevance of p53 and bcl-2 immunoreactivity as well as the percentage of apoptotic tumor cells in early invasive pT1/pT2 tumors managed with standard operations for gastric adenocarcinoma.

METHODS

Histologic slides of 65 pT1/pT2 gastric carcinomas were investigated for bcl-2 and p53 immunoreactivity. For 35 patients, DNA fragmentation of tumor cell nuclei was determined by the terminal uridine 5'-triphosphate (UTP) nick end-labeling (TUNEL) method. Follow-up evaluation of the patients was prospectively documented for 53.4 +/- 4.1 months.

RESULTS

Findings showed that bcl-2 immunoreactivity was associated with tumors of the intestinal type according to Lauren s classification (p = 0.042), and that p53 immunoreactivity was increased in more invasive tumors (pT1 vs pT2 tumors; p = 0.047). Mean survival time was significantly longer for patients with bcl-2-negative tumors (74.3 +/- 6.8 months) than for patients with bcl-2-positive tumors (50.8 +/- 7.6 months; p = 0.024). The percentage of apoptotic tumor cell nuclei did not have prognostic relevance in the population studied and was not associated with several histopathologic parameters or bcl-2 and p53 immunoreactivity. Subgroup analysis indicated that the survival of patients with differentiated G2 and bcl-2-negative/p53-negative tumors was significantly longer (82 +/- 6 months) than the survival of patients with G2 bcl-2- and/or p53-positive tumors (41.8 +/- 12.5 months; p = 0.005), with independent prognostic relevance determined by multivariate analysis (p = 0.024).

CONCLUSION

The data reported indicate that the analysis of bcl-2 and p53 immunoreactivity seems to have prognostic implications for early invasive (pT1/pT2) gastric adenocarcinomas and may subclassify patients for minimally invasive laparoscopic or endoscopic gastric resections.

Dealing with the "always sick" employee

Somatoform disorders occasionally surface in employees and others who, ordinarily unknowingly, are reacting to the stresses in their lives. Somatization is a process by which individuals communicate psychological distress through physical symptoms, thus essentially making themselves ill. However, by learning to recognize the signs of possible somatic problems the manager can apply various strategies to decrease an employee's apparent physical problems and enhance job performance.

Iris yellow spot virus on Onion in New Mexico

Onions are an important crop for New Mexico with 7,700 acres (3,116 ha) harvested in the state in 2003 (3). In 2002, onions of several cultivars were first noticed with diamond-shaped chlorotic or bleached lesions on seed stalks or leaves, typical of those reported for Iris yellow spot virus (IYSV). A more widespread survey of breeding stocks and commercial onion fields revealed similar symptoms on thrips-infested onions in Dona Ana and Rio Arriba counties. Incidence of disease symptoms ranged from <0.5 to nearly 30%. Symptomatic leaves were assayed for the presence of IYSV using enzyme-linked immunosorbent assay (ELISA; Agdia, Elkhart, IN) and antisera acquired from Agdia. Symptomatic leaves from breeding and commercial fields tested positive for IYSV. The virus was transmitted by Thrips tabaci from symptomatic onions to three onion cvs. New Mex Mesa, New Mex Vado, and New Mex Cryspy in growth chamber tests. All three cultivars showed symptoms of IYSV and tested positive for the disease using ELISA. However, New Mex Vado and New Mex Cryspy cultivars each showed 24% infection (4 infected plants of 17 tested) compared with 59% infection (10 infected plants of 17 tested) for New Mex Mesa, suggesting that not all cultivars are equally susceptible to the virus. To our knowledge, this is the first report of IYSV in onions in New Mexico, which has also been reported in the western United States in Idaho, Oregon, Colorado, and Washington (1,2,4). References: (1) L. J. du Toit et al. Plant Dis. 88:222, 2004. (2) J. M. Hall et al. Plant Dis. 77:952, 1993. (3) National Agricultural Statistics Service, On-line publication. USDA, 2004. (4) H. F. Schwartz et al. Plant Dis. 86:560, 2002.

New mixed alkali effect in the ac conductivity of ion-conducting glasses

We have determined the first wide-range conductivity spectra of a mixed alkali glass system, extending from 10(-3) Hz to 1.3 THz. We report on a new mixed alkali effect in the ac conductivity that is evident even if the low-frequency contributions (linked to hopping motions of the mobile cations) are removed from the experimental spectra. From our results we conclude that the nonhopping contributions to the ac conductivity involve both the mobile ions and the glassy network.

"The best thing about the hospitalization was that the nurses kept me well informed" Issues and strategies of client education

The patient had been in an automobile accident and was recuperating from a brain concussion. He was scheduled for 24 h of evaluative procedures to rule out injuries which might require surgery. He had been on a back board for a possible spine injury, had a variety of X-rays, blood work, and an EKG, and had been given oxygen, medication by injection, and intravenous fluid and medication through a pump. A variety of health team members including nurses, physicians, and a surgeon had done assessments and taken a history to assist in the diagnostic process. "The best thing about the hospitalization was the nurses telling me what they are doing and why they are doing it! It was really reassuring to have the procedures explained and to know what is being done and why." "I didn't always know if they were going through the steps to help remind themselves what they were doing or to tell me what they were doing. In either case, it was helpful for me to have information on what was happening." "They answered my questions as best they could. When I asked the nurse adding an IV bag what was in it he said, "Potassium" and he explained that my level was 3.3 when the normal was 3.5 to 5.0. He said that since they didn't know my normal they were giving me potassium just in case I needed it. He knew just what he was talking about and the facts were reassuring." "When I asked him to explain what the injection was, he said it was "Tetanus." He said I could refuse it if I wanted to, that it would probably get sore. However, he said I did have open abrasions and if I had not had one in 10 years it would be a good idea. So understanding this reasoning, I was glad to get the shot." "Patient education is really important. When I was in the hospital 10 years ago I was not given all this information and it really helps! I really appreciate the different approach by the nurses. It is really reassuring."

Impact of epidermal growth factor (EGF) radioreceptor analysis on long-term survival of gastric cancer patients

BACKGROUND

The EGF receptor/ligand system seems to be involved in the regulation of gastric mucosa proliferation and progression of gastric carcinomas.

PATIENTS AND METHODS

EGF receptor levels were quantitatively determined in 47 gastric carcinomas by 125J [EGF] radioreceptor assays in membrane preparations of tumor samples or corresponding adjacent mucosa. Specific receptor binding was determined by the analysis of displacement curves by non-linear least-square regression analysis using an estimated model of 'goodness of fit'.

RESULTS

Increased EGF receptor binding was observed in gastric carcinomas (mean +/- SEM: 11.87 +/- 1.9 fmol/mg protein) in comparison to adjacent normal gastric mucosa ( 5.28 +/- 1.0 fmol/mg protein, p = 0.003). Elevated EGF receptor levels were especially found in more invasive T3/4 carcinomas, tumors with positive lymph nodes, advanced UICC III carcinomas, undifferentiated tumors, carcinomas of the diffuse-type according to Lauren's classification and gastric carcinomas localized distal from the cardia. In histopathologically normal appearing gastric mucosa, EGF-receptor levels were significantly decreased relative to corresponding tumor samples from advanced UICC stages (UICC I vs UICC I/II: p = 0.008) or tumors with low levels of differentiation (G2 vs G3: p = 0.028). Overall survival was significantly reduced in patients with advanced gastric carcinomas according to UICC classification (UICC III vs UICC I/II: 18.8 vs 45.5 months, p = 0.016). A subgroup analysis of gastric carcinomas localized distal from the cardia indicated, that increased EGF-receptor levels were an independent indicator of poor prognosis as determined by univariate (p = 0.020) and multivariate analysis (p = 0.042).

CONCLUSION

Gastric carcinomas with increased EGF receptors might be a possible target for anticancer strategies blocking the EGF receptor/ligand pathway.

The employee who seeks to benefit from being ill

The presence of physical symptoms that do not correlate with a disease process are often frustrating to healthcare professionals, are difficult to diagnose and may consume an inordinate proportion of healthcare resources. However, proper and complete physical and psychological assessment and treatment is becoming increasingly possible and essential. Physical illness may occur concomitantly and sometimes as a result of psychological distress, which has displayed itself in a diagnosed mental illness. In other cases physical symptoms may be caused by unconscious dynamics, and the process becomes the primary presenting mental concern. In other cases the physical illness is part of a conscious process and motivated by the hope of gain. Differentiation between physical symptoms of unconscious and conscious origin is important in selecting the correct response. A manager must first of all be alert for physical symptoms that appear to be consciously motivated, as in a disorder called "malingering." The essential feature of malingering is the intentional production of false or grossly exaggerated physical or psychological symptoms, motivated by external incentives such as avoiding work or obtaining financial compensation. Managers may inadvertently encourage malingering in the workplace by inappropriate responses to employees who present a physical complaint that is consciously motivated for gain. When the manager can recognize this phenomenon as malingering, appropriate managerial intervention can cause this behavior to be controlled and even eliminated and thus enhance productivity.

Antibiotic susceptibility profiles of Escherichia coli strains lacking multidrug efflux pump genes

The contribution of seven known and nine predicted genes or operons associated with multidrug resistance to the susceptibility of Escherichia coli W3110 was assessed for 20 different classes of antimicrobial compounds that include antibiotics, antiseptics, detergents, and dyes. Strains were constructed with deletions for genes in the major facilitator superfamily, the resistance nodulation-cell division family, the small multidrug resistance family, the ATP-binding cassette family, and outer membrane factors. The agar dilution MICs of 35 compounds were determined for strains with deletions for multidrug resistance (MDR) pumps. Deletions in acrAB or tolC resulted in increased susceptibilities to the majority of compounds tested. The remaining MDR pump gene deletions resulted in increased susceptibilities to far fewer compounds. The results identify which MDR pumps contribute to intrinsic resistance under the conditions tested and supply practical information useful for designing sensitive assay strains for cell-based screening of antibacterial compounds.

The health care employee with an "attitude"

Health care managers may encounter employees who seem to have an "attitude." The employee may have a pattern of ingrained, inflexible, maladaptive responses to anxiety indicative of a personality disorder. When the employee has a pervasive sense of self-importance, is preoccupied with fantasies of unlimited success, and requires excessive admiration, a narcissistic personality disorder or traits may be present. Although this individual can cause havoc in the workplace, an alert manager who uses specific management techniques can enable the narcissistic employee to be productive and to be an asset in the work setting. This article provides a look at the etiology, symptoms, and management of the narcissistic employee. When the employee is willing to be assisted, the behavior can be modified and the necessary level of adaptation can occur. This can result in a more productive, less chaotic workplace.

Lung water, hemodynamics and dyspnea before and after valvuloplasty in mitral stenosis

The investigation was to elucidate the role of the reduction of extravascular pulmonary fluid in the immediate symptomatic improvement and its impact on hemodynamics in patients with mitral stenosis treated by percutaneous transluminal valvuloplasty.

METHODS

In a prospective study of 12 patients with severe mitral stenosis extravascular pulmonary fluid volume was determined by a combined dye and thermodilution technique (COLD Z-021(TM) Version 5.x, Pulsion((R))) before and after valvuloplasty. Cardiac output, left atrial pressures, atrial V-waves, diastolic transmitral gradients and their respiratory changes were measured. Dyspnea was assessed by validated questionnaires.

RESULTS

Symptomatic improvement correlated (r=0. 808) with a decrease of extravascular lung water, but not with either an increase or a decrease of cardiac output or left atrial filling pressures. The decrease of the lung water index may be predicted from the lung water index before valvuloplasty, the final left atrial mean pressure and the cardiac index prior to intervention. The change of the mean difference between inspiratory and expiratory mitral gradient demonstrated a significant inverse correlation with the change of mean left atrial filling pressures (r=-0.778) and with extravascular lung water after valvuloplasty (r=-0.871).

CONCLUSION

There is a complex relationship between left atrial filling pressures, extravascular lung water, respiratory changes of gradients, and dyspnea that need further investigation.

Biosynthesis of the lantibiotic mersacidin: organization of a type B lantibiotic gene cluster

The biosynthetic gene cluster (12.3 kb) of mersacidin, a lanthionine-containing antimicrobial peptide, is located on the chromosome of the producer, Bacillus sp. strain HIL Y-85,54728 in a region that corresponds to 348 degrees on the chromosome of Bacillus subtilis 168. It consists of 10 open reading frames and contains, in addition to the previously described mersacidin structural gene mrsA (G. Bierbaum, H. Brötz, K.-P. Koller, and H.-G. Sahl, FEMS Microbiol. Lett. 127:121-126, 1995), two genes, mrsM and mrsD, coding for enzymes involved in posttranslational modification of the prepeptide; one gene, mrsT, coding for a transporter with an associated protease domain; and three genes, mrsF, mrsG, and mrsE, encoding a group B ABC transporter that could be involved in producer self-protection. Additionally, three regulatory genes are part of the gene cluster, i.e., mrsR2 and mrsK2, which encode a two-component regulatory system which seems to be necessary for the transcription of the mrsFGE operon, and mrsR1, which encodes a protein with similarity to response regulators. Transcription of mrsA sets in at early stationary phase (between 8 and 16 h of culture).

Gender differences in leadership in the health professions

The leadership characteristics and behaviors of men and women differ. As increasing numbers of women enter positions of leadership, understanding of these differences can increase the quality and productiveness of relationships in the workplace. This article describes the evolution of women in leadership, gender differences in leadership style, and the way gender may affect behaviors in the workplace.