Effective lovastatin therapy in elderly hypercholesterolemic patients — an antioxidative impact?

The effect of 3 months lovastatin therapy on serum lipids, apolipoproteins, alpha-tocopherol and red cell membrane fatty acid pattern was assessed in twelve elderly ambulatory patients (mean age 70.9+/-8.0 years) with hypercholesterolemia type IIa according to Fredrickson. After a run-in period of 4 weeks without drug therapy, the patients were given a daily dose of 20 mg lovastatin. The treatment resulted in statistically significant decreases in mean serum low density lipoprotein cholesterol (LDL-CH, -34%), in the atherogenic index LDL-CH/HDL-CH (-35%) and in the concentration of apolipoprotein B (-26%). No change in the vitamin E status, as related to plasma total lipids, was observed during the 3 months of therapy. The fatty acid pattern of phospholipids from red cell membranes showed an increase in linoleic acid metabolites and a decrease in the precursor linoleic acid, indicating an induction of fatty acid desaturases by lovastatin. In addition, an increase in the plasmalogen portion of erythrocyte membrane phospholipids was exhibited by increases in the proportion of fatty aldehyde dimethyl acetals (DMA) in the fatty acid pattern. The plasmalogens increase may counteract the slow but consistent decrease in their concentration in red cell membranes and human aortas with increasing donor age and in arteriosclerosis. Since plasmalogens may function as physiological antioxidants, the observed increase in DMA concentration might reflect a previously unrecognized antioxidative principle of a lovastatin therapy.

Influence of age, frailty and liver function on the pharmacokinetics of brofaromine

OBJECTIVE

The pharmacokinetics of brofaromine, a selective inhibitor of monoamine oxidase A, was evaluated in 12 frail elderly patients (66-92 y) and 12 healthy volunteers (20-35 y).

METHODS

Quantitative liver function tests were performed to show whether brofaromine elimination in the elderly could be predicted from noninvasive assessment of CYP1A2 activity (caffeine clearance) or liver plasma flow (sorbitol clearance).

RESULTS

In the elderly the AUC of brofaromine was significantly increased (e.g. for the 75 mg dose 43.2 vs 19.9 mumol*h.l-1, clearance was reduced (5.0 vs. 11.8 l.h-1), the volume of distribution was smaller (130 vs. 230 l), and the half-life was slightly increased (19.0 vs. 14.2 h). No significant correlation was observed between hepatic plasma flow and brofaromine clearance (r = 0.41, P = 0.05), whereas CYP1A2 activity and brofaromine clearance were tightly correlated (r = 0.94, P < 0.0001).

CONCLUSION

Caffeine clearance, a simple, noninvasive test of CYP1A2 activity, is predictive of brofaromine clearance.

CQI: using the Hoshin planning system to design an orientation process

The Hoshin planning system, developed in Japan after World War II, includes management tools intended specifically for planning new processes. There are seven tools, which can be used individually or in any combination: affinity diagrams, interrelationship digraphs, systematic diagrams, matrix diagrams, process decision program charts, arrow diagrams and prioritization matrices. The radiology department at Carson-Tahoe Hospital formed a CQI team to improve the training of front office clerks. The team quickly discovered that a new orientation program was needed and decided to use Hoshin tools to create one. Using the tools, the team identified and prioritized all relevant factors, described specific tasks needed to complete the planning process and how long each would take, anticipated problems, and assigned areas of responsibility to members of the team. Each time the team grew weary or discouraged, the clarity and organization afforded by the tools helped them feel productive and in control of the process. The team was amazed at the creative ideas they generated through this 3-month-long process. Not only did they develop and implement a new orientation program, they also cultivated a stronger sense of pride and confidence in their work and each other.

Seizure induced C-Fos mRNA in the rat brain: comparison between young and aging animals

The molecular mechanisms associated with age-related alterations in the pharmacological and physiological properties of hippocampal and cortical neurons in response to chemically induced seizure are largely unknown. Administration of pentylenetetrazole (PTZ) (50 mg/kg body weight) to rats of various ages evoked tonic-colonic seizures. Using RNA gel blot analysis we found that 1 h after the onset of seizure, the mRNA for the protooncogene c-fos was increased in the hippocampus and cortex of 3-month-old rats. The levels of c-fos mRNA in the hippocampus and cortex of 3-month-old rats returned to control levels by 3 h after PTZ administration. The levels of c-fos mRNA in the hippocampus and cortex of 20-month-old and 30-month-old rats peaked at 3 h and returned to basal levels by 15 h following PTZ treatment. These results suggest that the induction of immediate-early gene expression, as exemplified by c-fos, is not impaired in the aged rat brain. However, the aged rat brain responded more slowly to chemically induced seizure and the levels of c-fos mRNA induction are decreased by about 49% in the cortex and by 27% in the hippocampus of 30-month-old rats, as compared to the levels expressed by 3-month-old rats.

Age-related dynamics of cognitive brain functions in humans: an electrophysiological approach

Event-related P300 potentials closely reflect cognitive functions such as stimulus discrimination (N250) and processing time (P300 latencies) as well as attention capabilities (P300 amplitudes). To delineate the age-related dynamics of P300 potentials, we investigated 250 healthy subjects between 18 and 98 years of age in a cross-sectional study. A total of 330 visual P300 tests was performed in two different paradigms (PI, passive condition, n = 80; PII, active condition, n = 250). In both P300 paradigms, the N250 and P300 latencies were markedly prolonged (p < .0001) in older age, whereas the N250 and P300 latency differences between PII and PI did not change (p > .05). The P300 amplitudes in paradigm I and II revealed only a slight age-related reduction. In fact, the P300 amplitude ratios between PII and PI remained constant. Third-order polynomial regressions provided the best fit of the aging-P300 interactions in paradigms I and II for both males and females. Interestingly, females showed a greater and possibly earlier P300 latency increase during aging than males. These age-related changes of P300 potentials indicate a rather mild cognitive decline that does not accelerate before old age and may be different between both sexes.

Training influence on age-dependent changes in the gait of rats

Stride length, stance width and gait symmetry were measured as parameters of gait analysis in young (5 months) and old (28 months) Sprague-Dawley rats following 3 months of treadmill running as well as in sedentary controls. Stride length decreased significantly with age and increased significantly following training in both young and old rats. Means of stance width increased significantly with age, but were unaffected by training. Gait symmetry declined with age; however, treadmill running counteracted the decline of gait symmetry. It was concluded that treadmill running compensates for or prevents age-related changes in the neuromuscular function of rats, which lead to gait deterioration.

The event-related P300 potential approach to cognitive functions of nondemented patients with cerebral and peripheral arteriosclerosis

OBJECTIVES

To detect subtle cognitive dysfunction in non-demented patients with either cerebral (cAD) or peripheral (pAD) arteriosclerotic disease, and to evaluate in these patients the effects on cognitive functions of carotid endarterectomy and bypass surgery, respectively.

DESIGN

Case-control study.

SETTING

Tertiary care referral center.

PARTICIPANTS

Eighty consecutive patients with moderate to high-grade stenosis of the internal carotid artery (ICA) (mean age +/- SD, 62 +/- 8 years), 53 patients with stenoses of the peripheral arteries (60 +/- 10 years), and 80 healthy volunteers (58 +/- 15 years) enrolled in a study on healthy aging. Cerebral and peripheral arteriosclerotic disease was verified by digital subtraction angiography, and all patients were screened for confounding effects of concomitant diseases.

MAIN OUTCOME MEASURES

Cognitive functions by event-related visual P300 potentials.

RESULTS

Patients with cAD showed prolonged P300 latencies and reduced P300 amplitudes, whereas pAD patients had reduced P300 amplitudes only. On an individual scale, 25% of cAD patients, but only 6% of pAD patients, revealed P300 abnormalities. In the cAD, but not in the pAD patients, the P300 latencies were especially prolonged in the older patients, but other factors such as sex, cerebral symptoms, degree of ICA stenosis, and premorbid intelligence did not play any role in either group. Within 1 to 2 weeks of surgery, the P300 latencies shortened in both cAD and pAD patients with high initial values.

CONCLUSIONS

As demonstrated by P300 potentials, even nondemented arteriosclerotic patients reveal signs of subtle cognitive dysfunction affecting especially the older cAD patient. In the short-term, carotid endarterectomy presumably improves cognitive functions unspecifically in nondemented patients with a higher initial degree of P300 abnormality.

Complement C1q and C3 mRNA expression in the frontal cortex of Alzheimer's patients

The levels and cellular localization of mRNA for complement C1q and C3 were examined by RNA gel blot and nonradioactive in situ hybridization in the frontal cortex of patients with Alzheimer's disease (AD) and age-matched controls. We found that the hybridization signal for C1q mRNA was markedly increased (approx. 3.5-fold) in the frontal cortex of AD patients compared to that in age-matched controls. In contrast to previous reports we also found that the levels of C3 mRNA, although well expressed, did not differ significantly between AD cases and age-matched controls. Nonradioactive in situ hybridization using digoxigenin-labeled ribo-probes revealed that transcripts coding for both C1q and C3 were closely associated with neurons. These results support the hypothesis that complement could play a role in neuronal degeneration which has been observed in the brain of AD patients.

Fibronectin mRNA (FN-V95+) is increased in the liver of old Sprague-Dawley rats: effect of food restriction

Because fibronectin (FN) mRNA has been shown to be increased in the brain of old rats and during in vivo and in vitro aging of both endothelial cells and fibroblasts, it was of interest to determine what effect age and caloric restriction have on the ability of liver cells to express FN mRNA. The prevalence of fibronectin mRNA containing the alternatively spliced variant V95 (FN-V95) was examined by RNA gel blot hybridization in the liver of 10-mo, 18-mo, 30-mo ad lib-fed (AL) and 30-mo food-restricted (FR) rats. The transcripts coding for FN-V95 mRNA were well expressed in the liver of 10-mo and 18-mo-old rats. The hybridization signal then increased (1.3-fold, p < .05) in the liver of 30-mo AL rats vs 10-mo-old rats. However, the prevalence of FN-V95 mRNA was dramatically decreased (approximately 4.5-fold, p < .01) in the liver of 30-mo food-restricted rats as compared to 30-mo-old AL rats. The distribution of FN-V95 mRNA was also investigated by non-radioactive in situ hybridization (ISH) on liver frozen sections. The hybridization signal for FN-V95 mRNA was evenly distributed among liver cells of 10-mo and 18-mo-old rats, while weak hybridization signals were sparsely scattered on liver sections derived from 30-mo-old FR rats. In contrast, strong hybridization signals showing a localized distribution were detected on liver sections obtained from 30-mo-old AL rats. Histologic examination of cryostat sections also revealed a massive accumulation of lipid droplets in the liver of 30-mo-old AL rats.(ABSTRACT TRUNCATED AT 250 WORDS)

Complete primary sequence of equine cartilage link protein deduced from complementary DNA

Investigation of the structure of the equine articular cartilage link protein (LP) from individuals ranging in age from 1 to 15 years identified 3 distinct isoforms having molecular weights of 46,000, 43,000 and 41,000. The relative amounts of each of the 3 isoforms altered with age. The largest form did not change with age; however, amounts of the Mr 43,000 and 41,000 forms increased with increasing age. The results suggested that an accumulation, in the extracellular matrix of cartilage, of these 2 smaller products may have arisen from proteolytic cleavage. The complete amino acid sequence of the protein core was determined from complementary DNA products prepared by polymerase chain reaction amplification of cartilage LP mRNA. The sequence had 96% similarity with human LP and with that of other species for which the primary structure has been determined. This high degree of sequence conservation and the isoform data indicate that extracellular processing of LP occurs by similar mechanisms in various species. At the transcription level, equine chondrocytes were found to express LP as 2 abundant mRNA of 5.0 and 3.0 kb, and a smaller mRNA of 1.5 kb. Processing of the LP m RNA in horses, thus, appears to be similar to that found in other species investigated, an although multiple transcripts are present, the coding region remains unaltered and only 1 protein product is made.

The response of umbilical vessels, with and without vascular endothelium, to local anesthesia in low PO2 and hypercarbia

BACKGROUND AND OBJECTIVES

Human umbilical vessels are sensitive to local anesthetic agents as well as to a variety of other exogenous and endogenous substances. Changes in blood gases such as hypoxia and hypercarbia may alter these responses. This study examined the effects of local anesthetic agents under these conditions and how the effects are related to the vascular endothelium.

METHODS

Veins and arteries, dissected from umbilical cords of healthy newborns, were cross-sectioned to form rings. The rings were mounted in a muscle chamber containing Krebs-Ringer bicarbonate solution that was gassed to approximate control, low PO2 or hypercarbic conditions. Changes in isometric tension were recorded in response to increasing concentrations of bupivacaine (B), lidocaine (L), or 2-chloroprocaine (2-CP). In half the experiments, intimal rubbing was used to remove the endothelium of rings for the purpose of disclosing the role of endothelial-derived factors.

RESULTS

The normal contracting (increasing baseline tone) or relaxing (decreasing baseline tone) responses to local anesthesia were unchanged by hypercarbia, but low PO2 suppressed the relaxing effect of 2-CP on arteries. Removal of endothelium enhanced the relaxing effect of 2-CP on arteries, and unmasked a contracting effect of L on arteries. Rubbed vessels, while exposed to low PO2 or hypercarbia, became less responsive to 2-CP.

CONCLUSIONS

Changes in the internal environment are capable of altering the response of umbilical vascular smooth muscle to local anesthesia. Additionally, the vascular endothelium appears to influence the degree of response to anesthesia.

Pentylenetetrazole-induced seizure up-regulates levels of microtubule-associated protein 1B mRNA and protein in the hippocampus of the rat

Stimuli that evoke seizure are capable of inducing structural changes in the hippocampus. However, late-acting genes related to these changes have not been described. Administration of pentylenetetrazole (PTZ; 50 mg/kg) to rats of various ages evoked tonic-clonic seizures. Using RNA gel blot analysis we found that the level of the mRNA for microtubule-associated protein 1B (MAP1B) was robustly increased in the hippocampus of 3-month-old rats. The levels of MAP1B mRNA in hippocampus peaked at 40 h and began to decline by 72 h following PTZ treatment. Immunoblotting with anti-MAP1B antibody demonstrates the increase in content of immunoreactive proteins 40-72 h after seizure onset in the hippocampus of PTZ-treated rats. These results indicate that MAP1B is a sensitive indicator of hippocampal structural changes occurring in response to PTZ-induced seizure activity.

Proteoglycan metabolism of equine articular cartilage and its modulation by insulin-like growth factors

The effect of human recombinant insulin-like growth factor 1 (rhIGF-1) on proteoglycan (PG) metabolism of full thickness equine articular cartilage explants was investigated. PG synthesis was stimulated at all ages, but higher concentrations of rhIGF-1 were required for maximal stimulation of adult cartilage. There were no changes in the hydrodynamic size, electrophoretic heterogeneity or composition of proteoglycans isolated from rhIGF-1-stimulated cartilage. rhIGF-1 reduced the rate of turnover of both newly synthesized and endogenous proteoglycans in all ages of cartilage investigated. The structure of proteoglycan fragments retained within the matrix and those released into the culture medium was unaffected by IGF-1 stimulation, suggesting that this peptide is a key regulator of the proteoglycan composition of equine articular cartilage extracellular matrix.

Palliative therapies in elderly cancer patients

Palliative therapy in elderly cancer patients deserves special attention because of differences between young and elderly cancer patients. In elderly patients, the treatment produces more adverse effects and the disease is cured less frequently, but the prognosis is usually better than in young patients with cancer. In the elderly population, cancer is seen more frequently than in the young population, yet elderly patients are less frequently included in trials. It is obvious that the results obtained from the treatment of young cancer patients do not necessarily apply to elderly cancer patients. The existing lack of formal data for the management of elderly cancer patients justifies 5 distinctive steps: collection of individual information; review of the available and appropriate knowledge; definition and specification of treatment goals; selection of treatment tools; and assessment of outcome. Following these steps will lead to coordination of oncology and palliative medicine.

[Age dependence of interleukin 6 and acute phase proteins]

In 59 healthy subjects of different age groups with no signs of inflammatory processes, the basal II-6 levels were measured. The II-6 concentrations were significantly higher in the oldest group (66-90 years) than in the two other age groups (24-40, 41-65 years). A positive correlation was found between age and II-6 concentration (r = 0.470). Otherwise, a statistically detectable relationship was found merely with alpha-2-macroglobulin and with total and LDL cholesterol.

Fibrin degeneration product concentrations (D-dimers) in the course of ageing

D-dimers, cross-linked fibrin split products, have been found to be an indicator of thromboembolic disease and may predict, as fibrinogen or other factors of hemostasis, a higher risk of cerebro- and cardiovascular diseases. D-dimers rose with advancing age in healthy elderly subjects and reached values well above the upper limit of the normal test values. The increase is considered to be the result of several causes, i.e. higher fibrinogen concentrations in the elderly, a slower urinary excretion, more frequent fibrin generation, (occult) diseases, risk factors, inflammatory reactions and degenerative vascular damage. In the elderly, moderately elevated D-dimers are therefore an unspecific finding. The specificity of the D-dimer test for diagnosing thromboembolic diseases can be expected to be lower than in young subjects.

Influence of age, treadmill running, and food restriction on plasma fibrinogen concentration and expression of gamma chain mRNA in female Sprague-Dawley rats

Plasma fibrinogen concentration and expression of mRNA encoding the gamma-chain of fibrinogen were determined in female Sprague-Dawley rats aged 10, 21 and 30 months. Both parameters increased significantly with age in a parallel fashion. Food restriction was able to reduce the age-dependent increase of both plasma concentration and gene expression to levels below young controls. On the other hand, long-term treadmill running failed to influence the plasma fibrinogen concentration. From these results we conclude that the plasma fibrinogen concentration increases with age due to an increased fibrinogen biosynthesis.

Interleukin-6 and selected plasma proteins in healthy persons of different ages

In the present study, interleukin-6 (IL-6) and several acute phase proteins were measured in healthy participants (23-87 years of age). A linear correlation between IL-6 and age was established with an increase of 0.016 pg/ml (0.004) per year of life. Whereas CRP remained below 0.5 mg/dl in all participants, an increase with age for fibrinogen and an inverse relation for albumin as well as transferrin were obtained. However, the increase of IL-6 did not correlate with any of these changes. IL-6 associated diseases may therefore occur more often with advancing age, but in healthy participants IL-6 does not explain the changing plasma protein pattern resembling that of an acute phase reaction.