Non-memory subjective cognitive concerns predict incident motoric cognitive risk syndrome

BACKGROUND AND PURPOSE

Motoric cognitive risk syndrome (MCR) is a predementia condition that combines slow gait and subjective cognitive concerns. As the earliest markers of MCR are relatively unknown, the role of subjective cognitive concerns was investigated to predict incident MCR in a well-characterized prospective cohort of non-demented older adults.

METHODS

Non-demented MCR-free older adults (n = 476) from the Central Control of Mobility in Aging cohort completed gait, subjective cognition and neuropsychological assessment at baseline and follow-up. Subjective concerns were analyzed via responses to 12 items from three validated measures, the Late-Life Function and Disability Instrument - Disability Component, the Activities of Daily Living Prevention Instrument and the Geriatric Depression Scale, and were independent of items utilized to diagnose MCR. Cox proportional hazard models examined the association between cognitive concerns and incident MCR.

RESULTS

After 2.36 ± 1.4 years, 28 participants developed MCR. Executive functioning (adjusted hazard ratio 2.458, 95% confidence interval 1.094-5.524, P = 0.029) and mental clarity concerns (adjusted hazard ratio 3.917, 95% confidence interval 1.690-9.077, P = 0.001) were associated with incident MCR, controlling for age, sex, education and gait speed.

CONCLUSIONS

Subjective cognitive concerns in non-memory cognitive domains predict incident MCR. Although most MCR studies assess cognitive concerns about memory, our findings suggest the need to broaden the scope of subjective cognitive assessment to enhance the accuracy of diagnosis and prediction of future cognitive decline.

Survival outcomes of diffuse large B-cell lymphoma by association with concurrent or antecedent follicular lymphoma and double hit status

Diffuse large B-cell lymphoma (DLBCL) transformed from follicular lymphoma (FL) (tDLBCL) has been traditionally associated with an aggressive course, but more recent studies have shown longer survivals. The clinical significance of concurrent FL at the time of diagnosis of DLBCL (cDLBCL/FL) is less clear. We compared outcomes of tDLBCL, cDLBCL/FL, and de novo DLBCL (dDLBCL) and then evaluated the impact of double hit (DH) rearrangements (MYC with BCL2 and/or BCL6) in these subgroups' outcomes. The progression free survival (PFS) and overall survival (OS) were not significantly different among the three groups (dDLBCL, tDLBCL, and cDLBCL/FL). The effect of DH on survival was then analyzed in two subgroups: (1) dDLBCL and (2) tDLBCL + cDLBCL/FL. PFS and OS were significantly shorter in lymphomas with DH in each of these two subgroups. We conclude that DH status drives outcomes in all DLBCLs, regardless of their transformation status.

Clinical recommendations for management of mesiodens and unerupted permanent maxillary central incisors

BACKGROUND

Un-erupted maxillary incisors may result secondary to supernumerary teeth. Despite the removal of such mesiodentes, orthodontic traction of a permanent un-erupted maxillary incisor may be required.

REVIEW

The literature regarding the impacted maxillary central incisor(s) was reviewed and all pertinent publications on the subject assessed. The review specifically relative to mesiodentes, surgical exposure and orthodontic management was interpreted together with the clinical experience of a number of the authors' cases. From this analysis a set of recommendations was developed.

RECOMMENDATIONS

(1) A sufficient arch space has to be ensured or orthodontically created for permanent maxillary central incisor(s). (2) Early surgical extraction of a mesiodens or mesiodentes (ideally before 7 years of age), with simultaneous closed surgical exposure of the permanent impacted maxillary incisor with bonding of an attachment with gold chain. (3) Re-evaluation after 2-3 months to assess for any natural eruption of the maxillary central incisor. (4) Application of orthodontic traction in the event of non-eruption.

CONCLUSION

Early diagnosis of the presence of mesiodentes is imperative. Appropriate surgical and/or orthodontic traction is often indicated with regular post-surgical follow-up assessments.

Preplacement assessments. Impact on injury outcomes

Evaluation of the impact of preplacement assessments is important given the resources companies and occupational health nurses allocate to screening and the ambiguity of the literature about the effectiveness of such assessments. This study examined the effects of preplacement assessments on employee injuries. All individuals screened by an occupational health clinic in the upper Midwest and given work restrictions during a 3 year period were identified as cases (n = 67). Cases were matched with controls without work restrictions (n = 264) on the basis of employer, gender, and job. Age was controlled for statistically. Chi-square analysis, used to test differences in percent distribution of injuries between cases and controls, found no statistically significant differences in musculoskeletal injuries between the groups. Work restrictions recommended as a result of preplacement assessments appear to protect vulnerable workers.

New endeavors and innovative programs in end of life care

This paper presents summaries of initiatives and demonstration programs developed by professional and patient care organizations to improve care at the end of life.

Olfactory bulbectomy as a model for agitated hyposerotonergic depression

Ablation of olfactory bulbs in rats reduced male sexual behavior, and altered the distribution of wheel-running activity between the light and dark phases of a 12:12 LD photoperiod. These effects were partially reversed by the tricyclic antidepressant amitriptyline. Olfactory bulbectomy also altered serotonin metabolism (5-HIAA/5-HT ratio) in the frontal cortex, nucleus accumbens, hippocampus and corpus striatum. These observations support the hypothesis that olfactory bulbectomy in rodents serves as a model of agitated hyposerotonergic depression.

Influence of lasalocid and supplement level on productivity of gestating ewes grazing winter range

Two winter feeding trials (1985-86; 1986-87) were conducted to evaluate the productivity of gestating ewes fed lasalocid (L) and two supplement levels while grazing Montana winter range. Five hundred range ewes were randomized within age and breed each year and allotted to .15 or .23 kg hd-1.d-1 of a 20% CP supplement and either no L or L at 70 mg hd-1.d-1. Feed treatments began on 18 Dec. approximately 100 d before the first expected lambing date and continued for 84 d. Ewes fed .23 kg of supplement per day gained more (P less than .01) total weight (4.9 vs 4.0 kg) during the 84-d experiment and had higher (P less than .05) grease fleece weights (4.2 vs 4.0 kg) than those fed .15 kg of supplement. Lasalocid had no effect (P greater than .05) on ewe weight change or grease fleece weights. Supplement level had no effect (P greater than .05) on reproduction, lamb mortality and lamb performance. Ewes fed L had a greater (P less than .05) percentage of lambs born per ewe than those not fed L (120.7 vs 112.1%); lamb performance was similar (P greater than .05) between treatments. However, because a greater percentage of lambs were born per ewe starting the experiment, ewes fed L produced more (P less than .05) kilograms of weaned lamb than those not fed L (25.9 vs 23.4 kg). In conclusion, ewes fed L and grazing winter range weaned more kg of lamb than did controls because of an improved lambing percentage.(ABSTRACT TRUNCATED AT 250 WORDS)