1
|
Verdin C, Zarick C, Steinberg J. Unique Challenges in Diabetic Foot Science. Clin Podiatr Med Surg 2024; 41:323-331. [PMID: 38388128 DOI: 10.1016/j.cpm.2023.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2024]
Abstract
In the past 30 years, there has been a rapid influx of information pertaining to the diabetic foot (DF) coming from numerous directions and sources. This article discusses the current state of the DF literature and challenges it presents to clinicians with its associated increase in knowledge on their derivations, complications, and interventions. Further, we attempt to provide tips on how to navigate and criticize the current literature to encourage and maximize positive outcomes in this challenging patient population.
Collapse
Affiliation(s)
- Craig Verdin
- Department of Plastic Surgery, MedStar Georgetown University Hospital, 3800 Reservoir Road NW, Washington DC 20007, USA
| | - Caitlin Zarick
- Department of Plastic Surgery, MedStar Georgetown University Hospital, 3800 Reservoir Road NW, Washington DC 20007, USA
| | - John Steinberg
- Department of Plastic Surgery, MedStar Georgetown University Hospital, 3800 Reservoir Road NW, Washington DC 20007, USA.
| |
Collapse
|
2
|
Meulenbroeks I, Mercado C, Gates P, Nguyen A, Seaman K, Wabe N, Silva SM, Zheng WY, Debono D, Westbrook J. Effectiveness of fall prevention interventions in residential aged care and community settings: an umbrella review. BMC Geriatr 2024; 24:75. [PMID: 38243175 PMCID: PMC10799511 DOI: 10.1186/s12877-023-04624-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Accepted: 12/18/2023] [Indexed: 01/21/2024] Open
Abstract
INTRODUCTION Preventing falls is a priority for aged care providers. Research to date has focused on fall prevention strategies in single settings (e.g., residential aged care (RAC) or community settings). However, some aged care providers deliver care, including fall prevention interventions, across RAC and community settings. We conducted an umbrella review to identify what type of fall prevention interventions had the greatest impact on falls outcomes in RAC and community settings. METHODS Five databases were searched for systematic reviews of falls prevention randomised control trials in older adults living in the community or RAC. Data extracted included systematic review methods, population characteristics, intervention characteristics, setting details (RAC or community), and fall-related outcomes (falls, people who have had a fall, fall-related hospitalisations, and fall-related fractures). Review quality was appraised using the Assessment of Multiple Systematic Reviews-2 tool. RESULTS One-hundred and six systematic reviews were included; 63 and 19 of these stratified results by community and RAC settings respectively, the remainder looked at both settings. The most common intervention types discussed in reviews included 'exercise' (61%, n = 65), 'multifactorial' (two or more intervention types delivered together) (26%, n = 28), and 'vitamin D' (18%, n = 19). In RAC and community settings, 'exercise' interventions demonstrated the most consistent reduction in falls and people who have had a fall compared to other intervention types. 'Multifactorial' interventions were also beneficial in both settings however demonstrated more consistent reduction in falls and people who fall in RAC settings compared to community settings. 'Vitamin D' interventions may be beneficial in community-dwelling populations but not in RAC settings. It was not possible to stratify fall-related hospitalisation and fall-related fracture outcomes by setting due to limited number of RAC-specific reviews (n = 3 and 0 respectively). CONCLUSION 'Exercise' interventions may be the most appropriate falls prevention intervention for older adults in RAC and community settings as it is beneficial for multiple fall-related outcomes (falls, fall-related fractures, and people who have had a fall). Augmenting 'exercise' interventions to become 'multifactorial' interventions may also improve the incidence of falls in both settings.
Collapse
Affiliation(s)
- Isabelle Meulenbroeks
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Rd North Ryde, Sydney, NSW, 2113, Australia.
| | - Crisostomo Mercado
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Rd North Ryde, Sydney, NSW, 2113, Australia
| | - Peter Gates
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Rd North Ryde, Sydney, NSW, 2113, Australia
- National Drug & Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
| | - Amy Nguyen
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Rd North Ryde, Sydney, NSW, 2113, Australia
- St Vincent's Clinical School, UNSW Medicine, UNSW Sydney, Sydney, NSW, Australia
| | - Karla Seaman
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Rd North Ryde, Sydney, NSW, 2113, Australia
| | - Nasir Wabe
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Rd North Ryde, Sydney, NSW, 2113, Australia
| | - Sandun M Silva
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Rd North Ryde, Sydney, NSW, 2113, Australia
| | - Wu Yi Zheng
- Black Dog Institute, University of New South Wales, Sydney, NSW, Australia
| | - Deborah Debono
- School of Public Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Johanna Westbrook
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Rd North Ryde, Sydney, NSW, 2113, Australia
| |
Collapse
|
3
|
Friedman JM, van Essen P, van Karnebeek CDM. Cerebral palsy and related neuromotor disorders: Overview of genetic and genomic studies. Mol Genet Metab 2022; 137:399-419. [PMID: 34872807 DOI: 10.1016/j.ymgme.2021.11.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Revised: 10/31/2021] [Accepted: 11/02/2021] [Indexed: 12/14/2022]
Abstract
Cerebral palsy (CP) is a debilitating condition characterized by abnormal movement or posture, beginning early in development. Early family and twin studies and more recent genomic investigations clearly demonstrate that genetic factors of major effect contribute to the etiology of CP. Most copy number variants and small alterations of nucleotide sequence that cause CP arise as a result of de novo mutations, so studies that estimate heritability on basis of recurrence frequency within families substantially underestimate genetic contributions to the etiology. At least 4% of patients with typical CP have disease-causing CNVs, and at least 14% have disease-causing single nucleotide variants or indels. The rate of pathogenic genomic lesions is probably more than twice as high among patients who have atypical CP, i.e., neuromotor dysfunction with additional neurodevelopmental abnormalities or malformations, or with MRI findings and medical history that are not characteristic of a perinatal insult. Mutations of many different genetic loci can produce a CP-like phenotype. The importance of genetic variants of minor effect and of epigenetic modifications in producing a multifactorial predisposition to CP is less clear. Recognizing the specific cause of CP in an affected individual is essential to providing optimal clinical management. An etiological diagnosis provides families an "enhanced compass" that improves overall well-being, facilitates access to educational and social services, permits accurate genetic counseling, and, for a subset of patients such as those with underlying inherited metabolic disorders, may make precision therapy that targets the pathophysiology available. Trio exome sequencing with assessment of copy number or trio genome sequencing with bioinformatics analysis for single nucleotide variants, indels, and copy number variants is clinically indicated in the initial workup of CP patients, especially those with additional malformations or neurodevelopmental abnormalities.
Collapse
Affiliation(s)
- Jan M Friedman
- Department of Medical Genetics, University of British Columbia, Vancouver, Canada
| | - Peter van Essen
- Department of Pediatrics, Amalia Children's Hospital, Radboud Centre for Mitochondrial Diseases, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Clara D M van Karnebeek
- Department of Pediatrics, Amalia Children's Hospital, Radboud Centre for Mitochondrial Diseases, Radboud University Medical Center, Nijmegen, the Netherlands; Departments of Human Genetics and Pediatrics, Emma Children's Hospital, Amsterdam University Medical Centres, Amsterdam, the Netherlands; Department of Pediatrics, Centre for Molecular Medicine and Therapeutics, University of British Columbia, Vancouver, Canada.
| |
Collapse
|
4
|
Werner C, Wolf-Belala N, Nerz C, Abel B, Braun T, Grüneberg C, Thiel C, Büchele G, Muche R, Hendlmeier I, Schäufele M, Dams J, König HH, Bauer JM, Denkinger M, Rapp K. A multifactorial interdisciplinary intervention to prevent functional and mobility decline for more participation in (pre-)frail community-dwelling older adults (PromeTheus): study protocol for a multicenter randomized controlled trial. BMC Geriatr 2022; 22:124. [PMID: 35164686 PMCID: PMC8842871 DOI: 10.1186/s12877-022-02783-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 01/24/2022] [Indexed: 01/19/2023] Open
Abstract
Background Age-related decline in physical capacity can lead to frailty, associated with an increased vulnerability to adverse health outcomes and greater healthcare utilization. In an aging population, effective strategies to prevent physical decline and frailty, and preserve independence are needed. Prevention programs for vulnerable community-dwelling older adults are, however, often not yet established and implemented in routine practice. Research on the feasibility, implementation, and (cost-)effectiveness of multifactorial, interdisciplinary intervention programs that take advantage of available services of healthcare providers is also limited. The main aim of this study is to evaluate the effectiveness of such an intervention program (PromeTheus) to prevent functional and mobility decline for more participation in community-dwelling (pre-)frail older adults. Methods The study is designed as a three-center, randomized controlled trial with a 12-month intervention period. Four hundred community-dwelling (pre-)frail (Clinical Frailty Scale score 4–6) older adults (≥70 years) will be randomized in a 1:1 ratio to the intervention group (IG) or the control group (CG). The IG will receive the PromeTheus program consisting of obligatory home-based physical exercises (Weight-bearing Exercise for Better Balance) accompanied by physiotherapists and facultative counseling services (person-environment-fit, coping with everyday life, nutrition, group-based activities) delivered via existing healthcare structures (e.g., social workers, nutritionists). The CG will receive usual care and a one-time counseling session on recommendations for physical activity and nutrition. Primary outcomes assessed at months 6 and 12 are the function component of the Late-Life Function and Disability Instrument and the University of Alabama at Birmingham Life-Space Assessment. Secondary outcomes are disability, physical capacity and activity, frailty, nutritional status, falls, fear of falling, health status, and psychosocial components. Process and economic evaluations are also conducted. Primary statistical analyses will be based on the intention-to-treat principle. Discussion Compared to usual care, the PromeTheus program is expected to result in higher function and mobility, greater independence and lower need for care, and more participation. As the PromeTheus program draws on existing German healthcare structures, its large-scale translation and delivery will be feasible, if evidence of (cost-)effectiveness and successful implementation can be demonstrated. Trial registration German Clinical Trials Register, . Registered on March 11, 2021.
Collapse
Affiliation(s)
- Christian Werner
- Center for Geriatric Medicine, Agaplesion Bethanien Hospital Heidelberg, Heidelberg University, Heidelberg, Germany.
| | | | - Corinna Nerz
- Department of Clinical Gerontology, Robert-Bosch-Hospital, Stuttgart, Germany
| | - Bastian Abel
- Center for Geriatric Medicine, Agaplesion Bethanien Hospital Heidelberg, Heidelberg University, Heidelberg, Germany
| | - Tobias Braun
- Division of Physiotherapy, Department of Applied Health Sciences, Hochschule für Gesundheit Bochum (University of Applied Sciences), Bochum, Germany
| | - Christian Grüneberg
- Division of Physiotherapy, Department of Applied Health Sciences, Hochschule für Gesundheit Bochum (University of Applied Sciences), Bochum, Germany
| | - Christian Thiel
- Division of Physiotherapy, Department of Applied Health Sciences, Hochschule für Gesundheit Bochum (University of Applied Sciences), Bochum, Germany
| | - Gisela Büchele
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Reiner Muche
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Ingrid Hendlmeier
- Department of Social Work, University of Applied Sciences, Mannheim, Germany
| | - Martina Schäufele
- Department of Social Work, University of Applied Sciences, Mannheim, Germany
| | - Judith Dams
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jürgen M Bauer
- Center for Geriatric Medicine, Agaplesion Bethanien Hospital Heidelberg, Heidelberg University, Heidelberg, Germany
| | - Michael Denkinger
- Institute for Geriatric Research, Ulm University, Ulm, Germany.,Agaplesion Bethesda Clinic, Ulm, Germany
| | - Kilian Rapp
- Department of Clinical Gerontology, Robert-Bosch-Hospital, Stuttgart, Germany
| |
Collapse
|
5
|
Fernández-Rio J, Pedrero Martínez Á. [Increasing one school's physical activity levels through a self-regulated, multifactorial intervention during recess.]. Rev Esp Salud Publica 2021; 95:e202109123. [PMID: 34477180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Accepted: 08/10/2021] [Indexed: 06/13/2023] Open
Abstract
OBJECTIVE Research has uncovered a global pandemic of physical inactivity and schools have been signaled as possible "agents" to modify these negative scores, since all children spend many hours a day there. The aim was to evaluate if it is possible to increase the physical activity levels of a whole school using a multifactorial, self-regulated intervention program during recess. METHODS A cross-sectional study was conducted involving all the students (N=50) of a rural public school located in northern Spain (grades 1-6). The study followed an ABA case study research design (changes in the experimentation conditions and data collection after each one: week 1 no intervention, weeks 2-3 intervention, week 4 no intervention) and mixed quantitative-qualitative methodology which included the use of accelerometers (each participant wore one during the whole school day and the school week), field notes (researcher) and focus groups (teachers). Normality tests, descriptive and inferential statistics (ANOVAs) were conducted in the quantitative data obtained, while thematic content and constant comparison analyses in the qualitative data. RESULTS Quantitative results showed that there was a significant increase to 67.15 ± 13.95 minutes/day of moderate-to-vigorous physical activity (MVPA) in week 2. Boys reached significantly higher scores than girls: 72.1 ± 12.12. Unfortunately, these scores went back to almost normal in the second week of implementation of the program (58.21 ± 12.88; boys= 62.75 ± 10.86). From the joined analysis of the researcher field notes and the teachers' focus groups 4 themes emerged: intensity change, dominance change, interactions change and self-regulation. CONCLUSIONS It is possible to increase the physical activity levels of a whole school with a multifactorial, self-regulated program, but it is necessary to acknowledge that novelty "wears out" to avoid losing efficacy with time.
Collapse
|
6
|
Meyer A, van der Merwe AE, Steyn M. An evaluation of the Acsádi and Nemeskéri Complex Method of adult age estimation in a modern South African skeletal sample. Forensic Sci Int 2021; 321:110740. [PMID: 33647568 DOI: 10.1016/j.forsciint.2021.110740] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 01/20/2021] [Accepted: 02/17/2021] [Indexed: 10/22/2022]
Abstract
The Acsádi and Nemeskéri Complex Method is a multifactorial adult age estimation method that makes use of weighting systems. The Complex Method employs the use of four skeletal elements in assessing age, including the degree of endocranial suture closure, age-related changes to the pubic symphyseal surface, and the internal structural changes observable in the proximal humerus and femur. Acsádi and Nemeskéri reported a very optimistic error margin of ±2.5 years when all four skeletal elements were used. Despite these promising results, the Complex Method's effectiveness has been questioned, suggesting that it results in a constant over- and underestimation of age in younger and older groups, respectively. In this study, the Complex Method was tested on a modern South African skeletal sample (n = 313) with individuals of known age-at-death. Results from this study to some extent justify the critique levelled against the Complex Method's tendency to over- and underestimate age. Nevertheless, the Complex Method still performed surprisingly well for certain skeletal element combinations. Contrary to Acsádi and Nemeskéri's findings, the use of all four skeletal elements did not provide more accurate age estimates. For the most part, combinations making use of three or two skeletal elements outperformed the use of all four skeletal indicators. Results from this study indicate caution in using a blanket approach when it comes to deciding on the best combination of skeletal elements used in multifactorial methods. It is suggested that the Complex Method may be optimised by making use of sex- and population-specific skeletal element combinations and weighting systems in the future.
Collapse
Affiliation(s)
- A Meyer
- Human Variation and Identification Research Unit, School of Anatomical Sciences, Faculty of Health Sciences, University of the Witwatersrand, South Africa.
| | - A E van der Merwe
- Department of Medical Biology, Amsterdam University Medical Centres, location AMC, University of Amsterdam, The Netherlands
| | - M Steyn
- Human Variation and Identification Research Unit, School of Anatomical Sciences, Faculty of Health Sciences, University of the Witwatersrand, South Africa
| |
Collapse
|
7
|
Maqsood A, Frome DK, Gibly RF, Larson JE, Patel NM, Sarwark JF. IS (Idiopathic Scoliosis) etiology: Multifactorial genetic research continues. A systematic review 1950 to 2017. J Orthop 2020; 21:421-6. [PMID: 32943828 DOI: 10.1016/j.jor.2020.08.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 08/09/2020] [Indexed: 11/22/2022] Open
Abstract
Objective IS (idiopathic scoliosis) is a common spinal condition occurring in otherwise completely healthy adolescents. The root cause of IS remains unclear. This systematic review will focus on an update of genetic factors and IS etiology. Though it is generally accepted that the condition is not due to a single gene effect, etiology studies continue looking for a root cause including genetic variants. Though susceptibility from multiple genetic components is plausible based on known family history data, the literature remains unclear regarding multifactorial genetic influences. The objective of this study was to critically evaluate the evidence behind genetic causes (not single gene) of IS through a systematic review and strength-of-study analysis of existing genetic and genome-wide association studies (GWAS). We used the protocol of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Methods PubMed was searched for the terms IS, scoliotic, spinal curve, genetic, gene, etiology, polymorphisms. Articles were assessed for risk-of-bias. Level-of-evidence grading was completed via Oxford Centre for Evidence-Based Medicine criteria. The assessment scores factor strength of a study in determining a positive or negative association to a gene etiology. Results After screening of 36 eligible papers, 8 relevant studies met inclusion criteria at this time, 3 were in favor of a genetic factor for IS, whereas 5 studies were against it. Conclusion Based on the literature analyzed, there is moderate evidence with a low risk-of-bias that does not clarify a genetic cause of IS. The 2 studies in favor of a genetic etiology were completed in homogeneous populations, limiting their generalizability. Relying on a genetic etiology alone for IS may over simplify its multifactorial nature and limit appreciation of other influences.
Collapse
|
8
|
Cook NS, Komansky BJ, Urton MS. Do No Harm: A Multifactorial Approach to Preventing Emergency Department Falls-A Quality Improvement Project. J Emerg Nurs 2020; 46:666-674. [PMID: 32507724 DOI: 10.1016/j.jen.2020.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 01/29/2020] [Accepted: 03/13/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Patient falls in the emergency department are a unique patient safety issue because of the often challenging nature of the environment. As there are a variety of potential causative factors for patient falls in the emergency department, this project employed a multifactorial approach to prevent patient falls in a Level 1 trauma center emergency department (adult only) in an urban tertiary care teaching hospital. METHODS This project was a single-unit quality improvement intervention that compared postintervention monthly unit-level data to historic monthly rates on the same unit. The intervention was multifaceted with patient-level, nurse-level, and unit-level interventions employed. A task force was convened to review and identify specific departmental gaps related to fall prevention, complete a retrospective review of departmental patient falls to determine causative factors, and implement interventions to reduce ED falls. A comprehensive program consisting of an ED-specific fall risk assessment tool, remote video monitoring (RVM), stretcher alarms, and a robust patient safety culture, among other interventions, was implemented. Patient falls and falls with injuries were tracked as an outcome measure. RESULTS After data driven analysis of causation, selection of key interventions, staff education, and sustained focus for 2 years, the department experienced a 27% decrease in falls and a 66% decrease in falls with injuries. DISCUSSION A multifactorial approach was an effective strategy to decrease patient falls in the emergency department.
Collapse
|
9
|
Saleem K, Zaib T, Sun W, Fu S. Assessment of candidate genes and genetic heterogeneity in human non syndromic orofacial clefts specifically non syndromic cleft lip with or without palate. Heliyon 2019; 5:e03019. [PMID: 31886431 PMCID: PMC6921104 DOI: 10.1016/j.heliyon.2019.e03019] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 11/25/2019] [Accepted: 12/06/2019] [Indexed: 12/26/2022] Open
Abstract
Non syndromic orofacial clefts specifically non-syndromic cleft lip/palate are one of the most common craniofacial malformation among birth defects in human having multifactorial etiology with an incidence of 1:700/1000. On the basis of association with other congenital malformations or their presence as isolated anomaly, OFC can be classified as syndromic (30%) and nonsyndromic (70%) respectively. The major cause of disease demonstrates complex interplay between genetic and environmental factors. The pathogenic mechanism of underlying factors have been provided by different genetic studies on large-scale with significant recent advances in genotyping technologies usually based on linkage or genome wide association studies (GWAS). On the basis of recent studies, new tools to identify causative genes involved in NSCL/P reported approximately more than 30 genetic risk loci that are responsible for pathogenesis of facial deformation. Despite these findings, it is still uncertain that how much of variance in NSCL/P predisposing factors can be explain by identified risk loci, as they all together accounts for only 20%-25% of NSCL/P heritability. So there is need of further findings about the problem of rare low frequency coding variants and other missing responsive factors or genetic modifiers. This review will described those potential genes and loci reported in different studies whose involvement in pathogenesis of nonsyndromic OFC has wide scientific evidence.
Collapse
Affiliation(s)
- Komal Saleem
- Laboratory of Medical Genetics, Harbin Medical University, Harbin 150081, China.,Key Laboratory of Preservation of Human Genetics Resources and Disease Control in China (Harbin Medical University), Ministry of Education, China
| | - Tahir Zaib
- Laboratory of Medical Genetics, Harbin Medical University, Harbin 150081, China.,Key Laboratory of Preservation of Human Genetics Resources and Disease Control in China (Harbin Medical University), Ministry of Education, China
| | - Wenjing Sun
- Laboratory of Medical Genetics, Harbin Medical University, Harbin 150081, China.,Key Laboratory of Preservation of Human Genetics Resources and Disease Control in China (Harbin Medical University), Ministry of Education, China
| | - Songbin Fu
- Laboratory of Medical Genetics, Harbin Medical University, Harbin 150081, China.,Key Laboratory of Preservation of Human Genetics Resources and Disease Control in China (Harbin Medical University), Ministry of Education, China
| |
Collapse
|
10
|
Dautel A, Eckert T, Gross M, Hauer K, Schäufele M, Lacroix A, Hendlmeier I, Abel B, Pomiersky R, Gugenhan J, Büchele G, Reber KC, Becker C, Pfeiffer K. Multifactorial intervention for hip and pelvic fracture patients with mild to moderate cognitive impairment: study protocol of a dual-centre randomised controlled trial (OF-CARE). BMC Geriatr 2019; 19:125. [PMID: 31039754 PMCID: PMC6492424 DOI: 10.1186/s12877-019-1133-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 04/09/2019] [Indexed: 01/13/2023] Open
Abstract
Background A hip or pelvic fracture is a major fall-related injury which often causes a decline in mobility performance and physical activity. Over 40% of patients with hip fracture have cognitive impairment or dementia and poorer rehabilitation outcomes than those without cognitive impairment. In this subgroup, there is a lack of evidence on the best practices supporting recovery. The main aim of this study is to investigate the effects of a transitional care intervention after inpatient rehabilitation on physical activity and functional performance in this group of cognitively impaired patients. Methods/design This dual-centre, randomised controlled trial compares a multifactorial intervention with usual care as control condition. Two hundred and forty community-dwellers (≥ 65 years) with a hip or pelvic fracture and mild to moderate cognitive impairment (MMSE 17–26) are recruited at the end of inpatient rehabilitation. The four-month intervention consists of (a) an individually tailored, progressive home exercise program and physical activity promotion delivered by professional instructors and lay instructors (two home visits per week) and (b) a long-term care counselling approach addressing unmet care needs, pleasurable activities, and caregiver issues if needed. Primary outcome parameters are physical activity, measured as daily walking duration with an accelerometer-based activity monitor (activPAL™) over 72 h, and functional performance, assessed with Short Physical Performance Battery sum scores. Secondary outcome parameters are fear of falling, fall related self-efficacy, falls, quality of life, depression and activity of daily living. Data are collected at the end of rehabilitation, before the intervention at the patient’s home (baseline), after four months (post-intervention), and seven months (follow-up). In addition to completer and intent-to-treat analyses of outcomes, economic data and incremental cost-effectiveness are analysed. Discussion Existing service models of volunteer services and legal counselling provided by care counsellors were considered when developing the intervention protocol. Therefore, it should be feasible to translate and deliver the intervention into real-world practice if it has been demonstrated to be effective. Trial registration German Clinical Trials Register, DRKS00008863 (Accessed 17 Apr 2019), ISRCTN registry, ISRCTN69957256 (Accessed 17 Apr 2019).
Collapse
Affiliation(s)
- Anja Dautel
- Department of Clinical Gerontology and Geriatric Rehabilitation, Robert-Bosch-Hospital, Auerbachstrasse 110, 70376, Stuttgart, Germany
| | | | - Michaela Gross
- Department of Clinical Gerontology and Geriatric Rehabilitation, Robert-Bosch-Hospital, Auerbachstrasse 110, 70376, Stuttgart, Germany
| | - Klaus Hauer
- Agaplesion Bethanien Hospital, Heidelberg, Germany
| | - Martina Schäufele
- Hochschule Mannheim, University of Applied Science, Mannheim, Germany
| | | | - Ingrid Hendlmeier
- Hochschule Mannheim, University of Applied Science, Mannheim, Germany
| | - Bastian Abel
- Agaplesion Bethanien Hospital, Heidelberg, Germany
| | - Rebekka Pomiersky
- Agaplesion Bethanien Hospital, Heidelberg, Germany.,Hochschule Mannheim, University of Applied Science, Mannheim, Germany
| | - Julia Gugenhan
- Department of Clinical Gerontology and Geriatric Rehabilitation, Robert-Bosch-Hospital, Auerbachstrasse 110, 70376, Stuttgart, Germany
| | - Gisela Büchele
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Katrin C Reber
- Department of Health Economics and Health Services Research, University Medical Centre Hamburg, Hamburg, Germany
| | - Clemens Becker
- Department of Clinical Gerontology and Geriatric Rehabilitation, Robert-Bosch-Hospital, Auerbachstrasse 110, 70376, Stuttgart, Germany
| | - Klaus Pfeiffer
- Department of Clinical Gerontology and Geriatric Rehabilitation, Robert-Bosch-Hospital, Auerbachstrasse 110, 70376, Stuttgart, Germany.
| |
Collapse
|
11
|
Gumus E. Comparison of two groups for the apolipoprotein E polymorphisms by using next generation sequencing: The first group with three consecutive abortions and the second group with at most one abortion in three consecutive pregnancies. Gene 2018; 668:8-11. [PMID: 29778421 DOI: 10.1016/j.gene.2018.05.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 05/07/2018] [Accepted: 05/16/2018] [Indexed: 11/29/2022]
Abstract
The importance of apolipoprotein E genotypes and allelic polymorphisms in the etiology of recurrent miscarriage is controversial. We plan to investigate this in a two-group study involving more than a thousand participants. In total, 1046 subjects (802 participants in the first group, 244 participants in the second group) were investigated. Women in the first group had a history of ≥3 consecutive spontaneous miscarriage and women in the second group had at most one miscarriage in three consecutive pregnancies. The participants with the following evidence and symptoms were excluded from both groups; structural uterine abnormality, chrosomal abnormalities and polymorphisms, hormonal imbalance, anti-nuclear antibodies, anti-phospholipid antibodies, lupus anticoagulant and homozygous genotype for FV-Leiden, MTHFR C677T, MTHFR A1298C, prothrombin 20210G>A and plasminogen activator inhibitor 4G/5G polymorphisms. We found similar apolipoprotein E allelic frequencies and genotype distributions in both groups. The frequencies of ε2 alleles were 4.1% in the first group and 2.9% in the second group, whereas those of ε3 alleles were 90.8% and 93% in the first group and the second group, respectively and ε4 alleles were 5.1% in the first group and 4.1% in the second group. The genotypes of Apo E observed in the first and the second group respectively were as follows; ε2/ε3 (7.5% and 5.7%), ε3/ε3 (82.7% and 86.5%), ε3/ε4 (8.7% and 7.4%), ε4/ε4 (0.5% and 0.4%) and ε2/ε4 (0.6% and 0). Our data did not support a possible association between apolipoprotein E genotypes and allelic frequencies, and recurrent miscarriages. We believe that the studies excluding the etiological factors that were previously found to be related with any condition are more valuable in the scope of showing the cause-effect relationship.
Collapse
Affiliation(s)
- Evren Gumus
- Department of Medical Genetics, Faculty of Medicine, University of Harran, 63000 Sanliurfa, Turkey.
| |
Collapse
|
12
|
Fuller J. Universal etiology, multifactorial diseases and the constitutive model of disease classification. Stud Hist Philos Biol Biomed Sci 2018; 67:8-15. [PMID: 29217262 DOI: 10.1016/j.shpsc.2017.11.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Revised: 11/01/2017] [Accepted: 11/03/2017] [Indexed: 06/07/2023]
Abstract
Infectious diseases are often said to have a universal etiology, while chronic and noncommunicable diseases are said to be multifactorial in their etiology. It has been argued that the universal etiology of an infectious disease results from its classification using a monocausal disease model. In this article, I will reconstruct the monocausal model and argue that modern 'multifactorial diseases' are not monocausal by definition. 'Multifactorial diseases' are instead defined according to a constitutive disease model. On closer analysis, infectious diseases are also defined using the constitutive model rather than the monocausal model. As a result, our classification models alone cannot explain why infectious diseases have a universal etiology while chronic and noncommunicable diseases lack one. The explanation is instead provided by the Nineteenth Century germ theorists.
Collapse
Affiliation(s)
- Jonathan Fuller
- Faculty of Medicine, University of Toronto, Canada; Research Associate, African Centre for Epistemology and Philosophy of Science, University of Johannesburg, South Africa.
| |
Collapse
|
13
|
Szentpetery SS, Gruzieva O, Forno E, Han YY, Bergström A, Kull I, Acosta-Pérez E, Colón-Semidey A, Alvarez M, Canino GJ, Melén E, Celedón JC. Combined effects of multiple risk factors on asthma in school-aged children. Respir Med 2017; 133:16-21. [PMID: 29173444 DOI: 10.1016/j.rmed.2017.11.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Revised: 10/31/2017] [Accepted: 11/02/2017] [Indexed: 01/14/2023]
Abstract
BACKGROUND Little is known about synergistic effects of several risk factors on asthma. We developed a risk score in Puerto Rican children, and then used this score to estimate the combined effects of multiple risk factors on asthma at school age in Puerto Rican and Swedish children. METHODS Case-control study in 609 Puerto Rican children (aged 6-14 years) and longitudinal birth cohort study of 2290 Swedish children followed up to age 12 years (The Children, Allergy, Milieu, Stockholm, Epidemiological Survey [BAMSE] Study). In both cohorts, there was data on parental asthma, sex, obesity, allergic rhinitis, and early-life second-hand smoke (SHS); data on diet and (in children ≥9 years) lifetime exposure to gun violence were also available in the Puerto Rico study. Asthma was defined as physician-diagnosed asthma and ≥1 episode of wheeze in the previous year. RESULTS In a multivariable analysis in Puerto Rican children, male sex, parental asthma, allergic rhinitis, early-life SHS, an unhealthy diet and (in children ≥9 years) gun violence were each significantly associated with asthma. We next created a risk score using these variables (range, 0 to 5-6 in Puerto Rico and 0 to 4 in BAMSE). Compared with Puerto Rican children without any risk factors (i.e. a score of 0), Puerto Rican children with 2, 3, and at least 4 risk factors had 3.6 times (95% CI = 1.4-9.2), 10.4 times (95% CI = 4.0-27.0), and 21.6 times (95% CI = 7.2-64.9) significantly higher odds of asthma, respectively. In BAMSE, the presence of 2, 3, and at least 4 risk factors was significantly associated with 4.1 times (95% CI = 2.3-7.4), 6.3 times (95% CI = 3.0-13.3), and 17.2 times (95% CI = 4.1-73.2) increased odds of asthma at age 12 years. CONCLUSIONS Our findings emphasize the multifactorial etiology of asthma, and suggest that concurrent eradication or reduction of several modifiable risk factors may better prevent or reduce the burden of childhood asthma.
Collapse
Affiliation(s)
- Sylvia S Szentpetery
- Division of Pulmonary Medicine, Allergy, and Immunology, Department of Pediatrics, Children's Hospital of Pittsburgh of UPMC, University of Pittsburgh, Pittsburgh, PA, United States
| | - Olena Gruzieva
- Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden
| | - Erick Forno
- Division of Pulmonary Medicine, Allergy, and Immunology, Department of Pediatrics, Children's Hospital of Pittsburgh of UPMC, University of Pittsburgh, Pittsburgh, PA, United States
| | - Yueh-Ying Han
- Division of Pulmonary Medicine, Allergy, and Immunology, Department of Pediatrics, Children's Hospital of Pittsburgh of UPMC, University of Pittsburgh, Pittsburgh, PA, United States
| | - Anna Bergström
- Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden; Centre for Occupational and Environmental Medicine, Stockholm County Council, Sweden
| | - Inger Kull
- Sachs' Children's Hospital, Södersjukhuset and the Department of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden
| | - Edna Acosta-Pérez
- Behavioral Sciences Research Institute, University of Puerto Rico, San Juan, Puerto Rico
| | - Angel Colón-Semidey
- Behavioral Sciences Research Institute, University of Puerto Rico, San Juan, Puerto Rico
| | - Maria Alvarez
- Centre for Occupational and Environmental Medicine, Stockholm County Council, Sweden
| | - Glorisa J Canino
- Behavioral Sciences Research Institute, University of Puerto Rico, San Juan, Puerto Rico
| | - Erik Melén
- Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden; Sachs' Children's Hospital, Södersjukhuset and the Department of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden
| | - Juan C Celedón
- Division of Pulmonary Medicine, Allergy, and Immunology, Department of Pediatrics, Children's Hospital of Pittsburgh of UPMC, University of Pittsburgh, Pittsburgh, PA, United States.
| |
Collapse
|
14
|
Abstract
Understanding the genetic risk factors for stroke is an essential step to decipher the underlying mechanisms, facilitate the identification of novel therapeutic targets, and optimize the design of prevention strategies. A very small proportion of strokes are attributable to monogenic conditions, the vast majority being multifactorial, with multiple genetic and environmental risk factors of small effect size. Genome-wide association studies and large international consortia have been instrumental in finding genetic risk factors for stroke. While initial studies identified risk loci for specific stroke subtypes, more recent studies also revealed loci associated with all stroke and all ischemic stroke. Risk loci for ischemic stroke and its subtypes have been implicated in atrial fibrillation (PITX2 and ZFHX3), coronary artery disease (ABO, chr9p21, HDAC9, and ALDH2), blood pressure (ALDH2 and HDAC9), pericyte and smooth muscle cell development (FOXF2), coagulation (HABP2), carotid plaque formation (MMP12), and neuro-inflammation (TSPAN2). For hemorrhagic stroke, two loci (APOE and PMF1) have been identified.
Collapse
Affiliation(s)
- Ganesh Chauhan
- Inserm U1219 Bordeaux Population Health Research Center, 146, rue Léo Saignat, 33000, Bordeaux, France.,University of Bordeaux, Bordeaux, France.,Centre for Brain Research, Indian Institute of Science, Bangalore, India
| | - Stéphanie Debette
- Inserm U1219 Bordeaux Population Health Research Center, 146, rue Léo Saignat, 33000, Bordeaux, France. .,University of Bordeaux, Bordeaux, France. .,Department of Neurology, Bordeaux University Hospital, Bordeaux, France.
| |
Collapse
|
15
|
Müller-Schwefe G, Morlion B, Ahlbeck K, Alon E, Coaccioli S, Coluzzi F, Huygen F, Jaksch W, Kalso E, Kocot-Kępska M, Kress HG, Mangas AC, Margarit Ferri C, Mavrocordatos P, Nicolaou A, Hernández CP, Pergolizzi J, Schäfer M, Sichère P. Treatment for chronic low back pain: the focus should change to multimodal management that reflects the underlying pain mechanisms. Curr Med Res Opin 2017; 33:1199-1210. [PMID: 28277866 DOI: 10.1080/03007995.2017.1298521] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
UNLABELLED Chronic low back pain: Chronic pain is the most common cause for people to utilize healthcare resources and has a considerable impact upon patients' lives. The most prevalent chronic pain condition is chronic low back pain (CLBP). CLBP may be nociceptive or neuropathic, or may incorporate both components. The presence of a neuropathic component is associated with more intense pain of longer duration, and a higher prevalence of co-morbidities. However, many physicians' knowledge of chronic pain mechanisms is currently limited and there are no universally accepted treatment guidelines, so the condition is not particularly well managed. DIAGNOSIS Diagnosis should begin with a focused medical history and physical examination, to exclude serious spinal pathology that may require evaluation by an appropriate specialist. Most patients have non-specific CLBP, which cannot be attributed to a particular cause. It is important to try and establish whether a neuropathic component is present, by combining the findings of physical and neurological examinations with the patient's history. This may prove difficult, however, even when using screening instruments. Multimodal management: The multifactorial nature of CLBP indicates that the most logical treatment approach is multimodal: i.e. integrated multidisciplinary therapy with co-ordinated somatic and psychotherapeutic elements. As both nociceptive and neuropathic components may be present, combining analgesic agents with different mechanisms of action is a rational treatment modality. Individually tailored combination therapy can improve analgesia whilst reducing the doses of constituent agents, thereby lessening the incidence of side effects. CONCLUSIONS This paper outlines the development of CLBP and the underlying mechanisms involved, as well as providing information on diagnosis and the use of a wide range of pharmaceutical agents in managing the condition (including NSAIDs, COX-2 inhibitors, tricyclic antidepressants, opioids and anticonvulsants), supplemented by appropriate non-pharmacological measures such as exercise programs, manual therapies, behavioral therapies, interventional pain management and traction. Surgery may be appropriate in carefully selected patients.
Collapse
Affiliation(s)
| | | | | | - Eli Alon
- d Universitätsspital Zurich , Zurich , Switzerland
| | | | - Flaminia Coluzzi
- f Department of Medical and Surgical Sciences and Biotechnologies , Sapienza University of Rome , Italy
| | - Frank Huygen
- g University Hospital , Rotterdam , The Netherlands
| | | | - Eija Kalso
- i Pain Clinic, Department of Anaesthesiology, Intensive Care and Pain Medicine , University of Helsinki, and Helsinki University Hospital , Finland
| | - Magdalena Kocot-Kępska
- j Department of Pain Research and Treatment , Collegium Medicum Jagiellonian University , Kraków , Poland
| | - Hans-Georg Kress
- k Department of Special Anaesthesia and Pain Therapy , Medizinische Universität/AKH Wien , Vienna , Austria
| | | | | | | | | | | | | | - Michael Schäfer
- r Department of Anaesthesiology and Intensive Care Medicine , Charité University Berlin, Campus Virchow Klinikum , Berlin , Germany
| | | |
Collapse
|
16
|
Dahal U, Sharma D, Dahal K. An Unsettled Debate About the Potential Role of Infection in Pathogenesis of Atherosclerosis. J Clin Med Res 2017; 9:547-554. [PMID: 28611853 PMCID: PMC5458650 DOI: 10.14740/jocmr3032w] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2017] [Indexed: 12/12/2022] Open
Abstract
Association of infection with atherosclerosis is by no means new. Several sero-epidemiological and pathologic studies as well as animal models have shown a link between infection and atherosclerosis. Exciting discoveries in recent times related to role of inter-individual genetic variation in modulating inflammatory response to infection have reignited the enthusiasm in proving a causal link between infection and atherosclerosis. The purpose of this article was to review and analyze the available evidence linking infection with atherosclerosis.
Collapse
Affiliation(s)
- Udip Dahal
- Department of Medicine, University of Utah, 50 N Medical Drive, Salt Lake City, UT, USA
| | - Dikshya Sharma
- Department of Internal Medicine, Staten Island University Hospital, 475 Seaview Avenue, Staten Island, NY, USA
| | - Kumud Dahal
- Department of Infectious Disease, University of Illinois College of Medicine at Peoria, 1 Illinoi Drive, Peoria, IL, USA
| |
Collapse
|
17
|
Abstract
Pulmonary hypertension is a complex disorder with multiple etiologies; the World Health Organization classification system divides pulmonary hypertension patients into 5 groups based on the underlying cause and mechanism. Group 5 pulmonary hypertension is a heterogeneous group of diseases that encompasses pulmonary hypertension secondary to multifactorial mechanisms. For many of the diseases, the true incidence, etiology, and treatment remain uncertain. This article reviews the epidemiology, pathogenesis, and management of many of the group 5 pulmonary hypertension disease states.
Collapse
Affiliation(s)
- Sara Kalantari
- Section of Cardiology, Department of Medicine, University of Chicago Medical Center, 5841 South Maryland Avenue, MC 5403, Chicago, IL 60637, USA
| | - Mardi Gomberg-Maitland
- Section of Cardiology, Department of Medicine, University of Chicago Medical Center, 5841 South Maryland Avenue, MC 5403, Chicago, IL 60637, USA; Pulmonary Hypertension Program, Cardiovascular Division, University of Chicago Medical Center, 5841 South Maryland Avenue, MC 5403, Chicago, IL 60637, USA.
| |
Collapse
|
18
|
Tordjman S, Cohen D, Coulon N, Anderson GM, Botbol M, Canitano R, Roubertoux PL. Reframing autism as a behavioral syndrome and not a specific mental disorder: Implications of genetic and phenotypic heterogeneity. Neurosci Biobehav Rev 2017; 80:210. [PMID: 28153685 DOI: 10.1016/j.neubiorev.2017.01.030] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 12/18/2016] [Accepted: 01/23/2017] [Indexed: 12/13/2022]
Abstract
Clinical and molecular genetics have advanced current knowledge on genetic disorders associated with autism. A review of diverse genetic disorders associated with autism is presented and for the first time discussed extensively with regard to possible common underlying mechanisms leading to a similar cognitive-behavioral phenotype of autism. The possible role of interactions between genetic and environmental factors, including epigenetic mechanisms, is in particular examined. Finally, the pertinence of distinguishing non-syndromic autism (isolated autism) from syndromic autism (autism associated with genetic disorders) will be reconsidered. Given the high genetic and etiological heterogeneity of autism, autism can be viewed as a behavioral syndrome related to known genetic disorders (syndromic autism) or currently unknown disorders (apparent non-syndromic autism), rather than a specific categorical mental disorder. It highlights the need to study autism phenotype and developmental trajectory through a multidimensional, non-categorical approach with multivariate analyses within autism spectrum disorder but also across mental disorders, and to conduct systematically clinical genetic examination searching for genetic disorders in all individuals (children but also adults) with autism.
Collapse
Affiliation(s)
- S Tordjman
- Pôle Hospitalo-Universitaire de Psychiatrie de l'Enfant et de l'Adolescent, Université de Rennes 1 and Centre Hospitalier Guillaume Régnier, 154 rue de Châtillon, 35200 Rennes, France; Laboratoire Psychologie de la Perception, Université Paris Descartes and CNRS UMR 8158, Paris, France.
| | - D Cohen
- Department of Child and Adolescent Psychiatry, AP-HP, GH Pitié-Salpétrière, CNRS FRE 2987, Université Pierre et Marie Curie, Paris, France
| | - N Coulon
- Laboratoire Psychologie de la Perception, Université Paris Descartes and CNRS UMR 8158, Paris, France
| | - G M Anderson
- Child Study Center, Yale University School of Medicine, New Haven, CT, USA
| | - M Botbol
- Departement Hospitalo-Universitaire de Psychiatrie de l'Enfant et de l'Adolescent, Université de Bretagne Occidentale, Brest, France
| | - R Canitano
- Division of Child and Adolescent Neuropsychiatry, University Hospital of Siena, Siena, Italy
| | - P L Roubertoux
- Aix Marseille Université, GMGF, Inserm, UMR_S 910, 13385, Marseille, France
| |
Collapse
|
19
|
Toghill BJ, Saratzis A, Bown MJ. Abdominal aortic aneurysm-an independent disease to atherosclerosis? Cardiovasc Pathol 2017; 27:71-75. [PMID: 28189002 DOI: 10.1016/j.carpath.2017.01.008] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Revised: 12/02/2016] [Accepted: 01/20/2017] [Indexed: 11/19/2022] Open
Abstract
Atherosclerosis and abdominal aortic aneurysms (AAAs) are multifactorial and polygenic diseases with known environmental and genetic risk factors that contribute toward disease development. Atherosclerosis represents an important independent risk factor for AAA, as people with AAA often have atherosclerosis. Studies have shown that comorbidity is usually between ~25% and 55%, but it is still not fully known whether this association is causal or a result of common shared risk profiles. Most recent epidemiological, clinical, and biological evidence suggests that the two pathologies are more distinct than traditionally thought. For instance diabetes mellitus, hypercholesterolemia, and obesity are high risk for atherosclerosis development but are not as pronounced in AAA, whereas smoking, gender, and ethnicity are particularly high risk for AAA but less so for atherosclerosis. In addition, genetic and epigenetic studies have identified independent risk loci involved in AAA susceptibility that are not associated with other cardiovascular diseases, and research on important common cardiovascular biomarkers has illustrated discrepancies in those with AAA.
Collapse
Affiliation(s)
- Bradley J Toghill
- Department of Cardiovascular Sciences and the NIHR Leicester Cardiovascular Biomedical Research Unit, University of Leicester, Leicester, UK..
| | - Athanasios Saratzis
- Department of Cardiovascular Sciences and the NIHR Leicester Cardiovascular Biomedical Research Unit, University of Leicester, Leicester, UK
| | - Matthew J Bown
- Department of Cardiovascular Sciences and the NIHR Leicester Cardiovascular Biomedical Research Unit, University of Leicester, Leicester, UK
| |
Collapse
|
20
|
De Ryck A, Fransen E, Brouns R, Geurden M, Peij D, Mariën P, De Deyn PP, Engelborghs S. Poststroke depression and its multifactorial nature: results from a prospective longitudinal study. J Neurol Sci 2014; 347:159-66. [PMID: 25451004 DOI: 10.1016/j.jns.2014.09.038] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2013] [Revised: 09/01/2014] [Accepted: 09/22/2014] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Poststroke depression (PSD) is commonly observed in stroke patients and has a negative impact on functional outcome and quality of life. Therefore, a prospective, longitudinal epidemiological study was conducted aiming to determine prevalence and risk factors for PSD at 1, 3, 6, 12 and 18 months poststroke. METHODS A total of 222 patients were included in the study and 201 patients entered data analysis. Demographic data, vascular risk factors, stroke characteristics, functional and neurocognitive outcome measures and psychosocial factors were considered as potential risk factors for PSD. Clinically significant signs and symptoms of PSD were quantified by means of the Cornell Scale for Depression (CSD) and the Montgomery and Åsberg Depression Rating Scale (MADRS). RESULTS PSD was present at 1, 3, 6, 12 and 18 months poststroke in 24.5%, 27.1%, 28.3%, 19.8% and 26.3% of the patients respectively. Univariate regression analyses revealed that PSD was significantly associated with stroke severity, physical disability, cognitive impairment and stroke outcome during the 18 months time frame of the study. Reduced social activities and the presence of apraxia were consistently associated with PSD whereas aphasia was only significantly associated in the first 6 months after stroke. Patients with relational problems had a 3 times greater risk of becoming depressed at 18 months poststroke than patients without relational problems (OR=3.09; 95% CI=1.31-7.26). CONCLUSIONS Risk factors for PSD seem variable indicating the need for clinicians to consider the dynamic and multifactorial nature of PSD emphasizing the importance of a rigorous and long-term monitoring and support of stroke patients and their caregivers.
Collapse
Affiliation(s)
- A De Ryck
- Department of Nursing and Midwifery Sciences, Faculty of Medicine and Health Sciences, University of Antwerp, Belgium; Department of Neurology and Memory Clinic, ZiekenhuisNetwerk Antwerpen (ZNA) Middelheim and Hoge Beuken, Belgium.
| | - E Fransen
- StatUa Center for Statistics, University of Antwerp, Belgium
| | - R Brouns
- Department of Neurology, Universitair Ziekenhuis Brussel, Center for Neurosciences (C4N), Vrije Universiteit Brussel (VUB), Brussel, Belgium
| | - M Geurden
- Department of Nursing and Midwifery Sciences, Faculty of Medicine and Health Sciences, University of Antwerp, Belgium; Department of Neurology and Memory Clinic, ZiekenhuisNetwerk Antwerpen (ZNA) Middelheim and Hoge Beuken, Belgium
| | - D Peij
- Department of Nursing and Midwifery Sciences, Faculty of Medicine and Health Sciences, University of Antwerp, Belgium
| | - P Mariën
- Department of Neurology and Memory Clinic, ZiekenhuisNetwerk Antwerpen (ZNA) Middelheim and Hoge Beuken, Belgium; Department of Neurolinguistics, Vrije Universiteit Brussel, Belgium
| | - P P De Deyn
- Department of Neurology and Memory Clinic, ZiekenhuisNetwerk Antwerpen (ZNA) Middelheim and Hoge Beuken, Belgium; Department of Health Care Sciences, Artesis University College of Antwerp, Antwerp, Belgium; University of Groningen, University Medical Center Groningen, Department of Neurology and Alzheimer Research Center, Netherlands; Reference Centre for Biological Markers of Dementia (BIODEM), Department of Biomedical Sciences, Institute Born-Bunge, University of Antwerp, Antwerp, Belgium
| | - S Engelborghs
- Department of Neurology and Memory Clinic, ZiekenhuisNetwerk Antwerpen (ZNA) Middelheim and Hoge Beuken, Belgium; Reference Centre for Biological Markers of Dementia (BIODEM), Department of Biomedical Sciences, Institute Born-Bunge, University of Antwerp, Antwerp, Belgium
| |
Collapse
|
21
|
Abstract
Multifunctional compounds (MFCs) are designed broadly as hybrid or conjugated drugs or as chimeric drugs from two or more pharmacophores/drugs having specific pharmacological activities. These are capable of eliciting multiple pharmacological actions and have emerged as magic bullets in treatment of multifactorial diseases. Many research articles disclosing the development of such compounds for treatment of multifactorial diseases are published during last 7 years. Some successful MFC candidates for multifactorial CNS disorders include ziprasidone, duloxetine, ladostigil and M-30 whereas sunitinib, lapatinib and synthetic oleandane triterpinoids are the successful MFC candidates for various cancers. Many more compounds derived from berberine, tacrine, artemisnin, quinine, NSAIDs, pralidoxine, donepezil, rivastigmine, curcumin and various antioxidants are under investigations for exploration of their multifunctional potential. In general, MFCs possess the advantages of reduced molecularity, no drug-drug interactions and improved pharmacokinetics and pharmacodynamics. A MFC derived from two or more different pharmacophores exerts its activities by interacting with respective receptors of its constituent pharmacophores. It may also exhibit additional binding interactions with the receptor sites that may be responsible for significantly improved or additional activities. The present review discusses various MFCs developed for specific class of disorders with an aim to provide an insight into the strategies in medicinal chemistry for development of such compounds.
Collapse
Affiliation(s)
- Yogita Bansal
- Molecular Modelling Lab (MML), Department of Pharmaceutical Sciences and Drug Research, Punjabi University, Patiala, Punjab 147002, India
| | - Om Silakari
- Molecular Modelling Lab (MML), Department of Pharmaceutical Sciences and Drug Research, Punjabi University, Patiala, Punjab 147002, India.
| |
Collapse
|
22
|
Lindor NM, Goldgar DE, Tavtigian SV, Plon SE, Couch FJ. BRCA1/2 sequence variants of uncertain significance: a primer for providers to assist in discussions and in medical management. Oncologist 2013; 18:518-24. [PMID: 23615697 DOI: 10.1634/theoncologist.2012-0452] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION DNA variants of uncertain significance (VUS) are common outcomes of clinical genetic testing for susceptibility to cancer. A statistically rigorous model that provides a pathogenicity score for each variant has been developed to aid in the clinical management of patients undergoing genetic testing. METHODS The information in this article is derived from multiple publications on VUS in BRCA genes, distilled for communicating with clinicians who may encounter VUS in their practice. RESULTS The posterior probability scores for BRCA1 or BRCA2 VUS, calculated from a multifactorial likelihood model, are explained, and links for looking up specific VUS are provided. The International Agency on Cancer Research (IARC) of the World Health Organization has proposed a simple five-tier system for clinical management that is not widely known to clinicians. Classes 1 and 2 in this system are managed as neutral variants, classes 4 and 5 are managed as pathogenic variants, and class 3 variants still have insufficient evidence to move to either end of this scale and, thus, cannot be used in medical management. CONCLUSIONS Development of models that integrate multiple independent lines of evidence has allowed classification of a growing number of VUS in the BRCA1 and BRCA2 genes. The pathogenicity score that is generated by this model maps to the IARC system for clinical management, which will assist clinicians in the medical management of those patients who obtain a VUS result upon testing.
Collapse
Affiliation(s)
- Noralane M Lindor
- Department of Health Sciences Research, Mayo Clinic, Scottsdale, Arizona 85259, USA.
| | | | | | | | | |
Collapse
|