Diabetes, comorbidities and increased long-term mortality in older patients admitted for geriatric inpatient care

AIMS

To study the specific impact of diabetes on long-term mortality in very old subjects with multiple comorbidities and functional disabilities.

METHODS

The prevalence of vascular disorders, global comorbidity load (cumulative illness rating scale [CIRS]) and functional disabilities (activities of daily living [ADL] and Lawton's instrumental ADL [IADL] scores) were determined according to diabetes status in a cohort of 444 patients (mean age 85.3±6.7 years; 74.0% women) admitted to our geriatric service. Also, the specific impact of diabetes on 4-year mortality was analyzed using Cox proportional-hazards models.

RESULTS

Diabetic patients had higher BMI scores (27.1±4.9 vs. 23.4±4.7 kg/m(2) in controls; P<0.001), and higher prevalences of hypertension (81.9% vs. 65.1%, respectively; P=0.003) and ischaemic heart disease (33.7% vs. 22.2%, respectively; P=0.033), but not of stroke and renal insufficiency. They also had more comorbidities (CIRS score excluding diabetes: 15.1±4.5 vs. 13.8±4.8, respectively; P=0.016) and functional disabilities. Diabetes was associated with mortality (HR: 1.42, 95% CI: 1.02-1.99; P=0.041) after adjusting for age, gender and BMI, and this persisted after adjusting for individual vascular comorbidities, but disappeared after adjusting for CIRS, ADL or IADL scores.

CONCLUSION

Diabetes was associated with 4-year mortality after adjusting for the inverse relationship between mortality and BMI. This association was better accounted for by the global comorbidity load and functional disabilities than by the individual vascular comorbidities. These findings suggest that the active management of all--rather than selected--comorbidities is the key to improving the prognosis for older diabetic patients.

Single-shot velocity-map imaging of attosecond light-field control at kilohertz rate

High-speed, single-shot velocity-map imaging (VMI) is combined with carrier-envelope phase (CEP) tagging by a single-shot stereographic above-threshold ionization (ATI) phase-meter. The experimental setup provides a versatile tool for angle-resolved studies of the attosecond control of electrons in atoms, molecules, and nanostructures. Single-shot VMI at kHz repetition rate is realized with a highly sensitive megapixel complementary metal-oxide semiconductor camera omitting the need for additional image intensifiers. The developed camera software allows for efficient background suppression and the storage of up to 1024 events for each image in real time. The approach is demonstrated by measuring the CEP-dependence of the electron emission from ATI of Xe in strong (≈10(13) W/cm(2)) near single-cycle (4 fs) laser fields. Efficient background signal suppression with the system is illustrated for the electron emission from SiO(2) nanospheres.

SDF1β expression in renal cell carcinoma correlates with grading and infiltration by CD8+ T-cells

For several tumor entities, a significant correlation between the chemokine stromal cell-derived factor 1 (SDF1) and its receptor C-X-C chemokine receptor type 4 (CXCR4), metastasis and tumor proliferation, as well as prognosis, has been described. In this study, a series of 105 renal cell carcinoma patients were analyzed in terms of expression of SDF1α and SDF1β and infiltration by CD4+ and CD8+ T-cells and the data correlated with TNM category, grading and survival. While the splice variant SDF1α had no impact on tumor grading, T-cell invasion or overall survival, expression of SDF1β showed a significant correlation with tumor grading and also suggested a correlation with metastasis, as well as CD8+ T-cell invasion. These results indicate a potential T-cell-mediated antitumor response induced by SDF1β up-regulation. Therefore targeting the SDF1β-CXCR4 signaling pathway may be a promising means for new therapeutic strategies in advanced tumor stages.

[Quality criteria for health promotion and primary prevention measures in association with obesity in children and adolescents. A BZgA-coordinated expert consensus]

On behalf of the Federal Ministry of Health, a working group coordinated by the Federal Center for Health Education (BZgA) compiled quality criteria for health promotion and primary prevention measures in association with obesity in children and adolescents that are applicable both to population-wide and to target group-specific measures. The criteria are intended to support the planning of new measures and the conceptual improvement of existing measures. Additional elements are the assessment of programs for financing purposes and the rendering of accounts to funding agencies, as well as the acquisition of further knowledge. The criteria, thus, address not only project developers and providers, but also multipliers who implement measures, as well as funding agencies, who can use the criteria as a basis for assessing the measures. The structure of the quality criteria is geared to the fundamental structure of the Public Health Action Cycle. In addition, resource orientation, participation and, above all, organizational development are important aspects associated with quality that have not been given adequate consideration to date. The quality criteria are applicable to all situation-based and behavioral prevention measures, and also development processes that focus on promoting the health and normal weight development of children and adolescents.

Severity of dependence modulates smokers' neuronal cue reactivity and cigarette craving elicited by tobacco advertisement

Smoking-related cues elicit craving and mesocorticolimbic brain activation in smokers. Severity of nicotine dependence seems to moderate cue reactivity, but the direction and mechanisms of its influence remains unclear. Although tobacco control policies demand a ban on tobacco advertising, cue reactivity studies in smokers so far have not employed tobacco advertisement as experimental stimuli. We investigated whether tobacco advertisement elicits cue reactivity at a behavioral (subjective craving) and a neural level (using functional magnetic resonance imaging) in 22 smokers and 21 never-smokers. Moreover, we studied the influence of severity of dependence on cue reactivity. In smokers, tobacco advertisement elicited substantially more craving than control advertisement whereas never-smokers reported no cue induced craving. Surprisingly, neuronal cue reactivity did not differ between smokers and never-smokers. Moderately dependent smokers' craving increased over the course of the experiment, whereas highly dependent smokers' craving was unaffected. Moderately dependent smokers' brain activity elicited by tobacco advertisement was higher in the amygdala, hippocampus, putamen and thalamus compared with highly dependent smokers. Furthermore, limbic brain activation predicted picture recognition rates after the scanning session, even in never-smokers. Our findings show that tobacco advertisement elicits cigarette craving and neuronal cue reactivity primarily in moderately dependent smokers, indicating that they might be particularly responsive towards external smoking-related cues. On the other hand, neuronal cue reactivity and cigarette craving in highly dependent smokers is more likely triggered by internal cues such as withdrawal symptoms. Tobacco advertisement seems to likewise appeal to smokers and non-smokers, clarifying the potential danger especially for young non-smokers.

Leukoencephalomalacia and Laminar Neuronal Necrosis Following Smoke Inhalation in a Dog

Acute respiratory and neurologic disease after smoke inhalation are well documented, but human patients may also develop delayed-onset neurologic symptoms associated with leukoencephalomalacia after exposure to smoke or carbon monoxide. In this case, a dog developed progressive neurologic signs 6 days after rescue from an apartment fire. At necropsy 9 days after smoke inhalation, leukoencephalomalacia of the central cerebral white matter was accompanied by laminar necrosis of cerebrocortical neurons. This is the first report of delayed posthypoxic leukoencephalopathy in a nonhuman animal.

Human dopamine receptor D2/D3 availability predicts amygdala reactivity to unpleasant stimuli

Dopamine (DA) modulates the response of the amygdala. However, the relation between dopaminergic neurotransmission in striatal and extrastriatal brain regions and amygdala reactivity to affective stimuli has not yet been established. To address this issue, we measured DA D2/D3 receptor (DRD2/3) availability in twenty-eight healthy men (nicotine-dependent smokers and never-smokers) using positron emission tomography with [18F]fallypride. In the same group of participants, amygdala response to unpleasant visual stimuli was determined using blood oxygen level-dependent (BOLD) functional magnetic resonance imaging. The effects of DRD2/3 availability in emotion-related brain regions and nicotine dependence on amygdala response to unpleasant stimuli were examined by multiple regression analysis. We observed enhanced prefrontal DRD2/3 availability in those individuals with higher amygdala response to unpleasant stimuli. As compared to never-smokers, smokers showed an attenuated amygdala BOLD response to unpleasant stimuli. Thus, individuals with high prefrontal DRD2/3 availability may be more responsive toward aversive and stressful information. Through this mechanism, dopaminergic neurotransmission might influence vulnerability for affective and anxiety disorders. Neuronal reactivity to unpleasant stimuli seems to be reduced by smoking. This observation could explain increased smoking rates in individuals with mental disorders.

How to search and harvest the medical literature: let the citations come to you, and how to proceed when they do

BACKGROUND

There is a virtual avalanche of medical information available to clinicians and researchers. The traditional 'search' can be substantially augmented by proactive 'harvesting.'

AIMS

To describe how to search and harvest the medical literature.

MATERIALS & METHODS

Survey of selected resources available on the internet.

RESULTS

PubMed remains the backbone of the traditional literature search. The availability of automated delivery of electronic tables of contents ('eTOCs'), electronic feeds of targeted search results, and workflow tools allows relevant articles to find the reader. Electronic storage and retrieval tools make it possible to manage this information and make day-to-day clinical and research activities more efficient.

DISCUSSION

Searching and harvesting the medical literature is made easier with the advent of the internet and email. In addition, there are internet resources that screen and filter potential articles of interest. Managing one's electronic library of PDF documents requires attention to appropriately naming files and the use of indexing programs.

CONCLUSION

In addition to readers searching for relevant citations, these citations themselves can be searching for readers. Clinicians and researchers can take advantage of this and efficiently harvest the medical literature with a modest investment of time.

Science journal editors' views on publication ethics: results of an international survey

BACKGROUND

Breaches of publication ethics such as plagiarism, data fabrication and redundant publication are recognised as forms of research misconduct that can undermine the scientific literature. We surveyed journal editors to determine their views about a range of publication ethics issues.

METHODS

Questionnaire sent to 524 editors-in-chief of Wiley-Blackwell science journals asking about the severity and frequency of 16 ethical issues at their journals, their confidence in handling such issues, and their awareness and use of guidelines.

RESULTS

Responses were obtained from 231 editors (44%), of whom 48% edited healthcare journals. The general level of concern about the 16 issues was low, with mean severity scores of <1 (on a scale of 0-3) for all but one. The issue of greatest concern (mean score 1.19) was redundant publication. Most editors felt confident in handling the issues, with <15% feeling "not at all confident" for all but one of the issues (gift authorship, 22% not confident). Most editors believed such problems occurred less than once a year and >20% of the editors stated that 12 of the 16 items never occurred at their journal. However, 13%-47% did not know the frequency of the problems. Awareness and use of guidelines was generally low. Most editors were unaware of all except other journals' instructions.

CONCLUSIONS

Most editors of science journals seem not very concerned about publication ethics and believe that misconduct occurs only rarely in their journals. Many editors are unfamiliar with available guidelines but would welcome more guidance or training.

[Efficacy and safety of probiotics]

Probiotics are bacteria or fungi, which modulate pathogenic growth and invasion of the bowel. The most frequently used are Lactobacillus and Saccharomyces cerevisiae. They are widely used as dietary supplements or for the treatment and prevention of various types of diarrhoea. Probiotics are generally considered as safe, but some cases of invasive infections have been described in different patient populations. This article reviews the literature about the indications and risks of probiotics, especially in immunocompromised patients.