Performance status and comorbidity in elderly cancer patients compared with young patients with neoplasia and elderly patients without neoplastic conditions

MARCKS, the major protein kinase C substrate in various cells and tissues, binds to calmodulin, acidic membrane phospholipids, and actin filaments, and these interactions are regulated by protein phosphorylation. We have previously analyzed MARCKS purified from bovine brain using capillary liquid chromatography/electrospray mass spectrometry and found that the protein structure differed significantly from that deduced from cDNA sequences [Taniguchi, H., Manenti, S., Suzuki, M., and Titani, K. (1994) J. Biol. Chem. 269, 18299-18302]. Moreover, the alignment of the protein from various species showed a lack of any conserved sequences in the C-terminal half of the molecule. This prompted us to reexamine the C-terminal amino-acid sequence of bovine MARCKS. The purified protein was digested with lysyl endoprotease, and the obtained C-terminal peptide was further digested with either Staphylococcus V8 protease or NTCB. The small peptides thus obtained were analyzed by liquid chromatography/electrospray/tandem mass spectrometry. This combined with gas-phase Edman sequencing allowed us to determine the C-terminal primary structure. The sequence obtained differed significantly from that reported previously, and the comparison with other species revealed the presence of a novel conserved domain in the C-terminal region of MARCKS.     

Depression in elderly spouse pairs

Men, women, and children are subject to a number of disease conditions that have been documented over many centuries. Among the most recently described and the least understood of these conditions are autoimmune diseases. As we unfortunately have seen in recent years, the obscure nature of autoimmune disorders has allowed scientific distortion by individuals who stand to profit by claiming a cause-and-effect relationship among some types of autoimmune conditions and a number of medical products, resulting in a rapidly expanding use of "junk science" in our courtrooms. Attempts have been made recently to implicate a number of environmental factors in the development of autoimmune disorders, most notably silicone gel-filled breast implants. The controversies surrounding these alleged relationships have proved to be among the most contentious, costly, and dangerous events ever to occur in women's health care.     

The effect of priming with vecuronium and rocuronium on young and elderly patients

The priming principle consists of administering a subparalyzing dose of nondepolarizing neuromuscular blocking drug 3-6 min before giving a second dose for tracheal intubation. This study was performed to observe the effects of priming doses of vecuronium and rocuronium on pulmonary function tests and muscular weaknesses in young (25-35 yr of age) and elderly (65-73 yr of age) patients. Ten young and 10 elderly patients were each placed in vecuronium and rocuronium groups. Oxygen saturation and train-of-four (TOF) ratio were determined, and pulmonary function tests were performed. Then 20% of the 95% effective dose (ED95) of the muscle relaxants was given intravenously. All tests were performed again 4 min after vecuronium and 3 min after rocuronium. Other signs of muscular weaknesses were also recorded. Elderly patients showed more signs of muscle weakness in both groups. The TOF ratio was 0.77 and 0.79 in the elderly rocuronium and vecuronium groups, respectively, and 0.89 and 0.90 in the young rocuronium and vecuronium groups, respectively. Dynamic spirometry revealed decreases in forced expiratory volume in 1 s and forced vital capacity in both groups, and no significant changes in peak expiratory flow rate. The expiratory reserve volume was reduced more in the elderly groups. Oxygen saturation decreased in both groups. We conclude that oxygen saturation, pulmonary function, and muscle strength decrease more in the elderly than in their younger counterparts from priming doses of vecuronium or rocuronium. IMPLICATIONS: The priming principle consists of giving a subparalyzing dose of muscle relaxant 3-6 min before giving a second dose for tracheal intubation. We found that priming doses of vecuronium and rocuronium produced greater decreases in oxygen saturation and pulmonary function in the elderly (aged 65-73 yr) than their younger (aged 25-35 yr) counterparts. Priming may not be a safe approach in elderly patients.     

Depression in the elderly in family practice

The typical chronic splanchnic syndrome is characterized by upper abdominal pain usually provoked by a meal, the finding of an epigastric bruit and weight loss in conjunction with haemodynamically significant stenosis of two or more of the splanchnic arteries. Diagnosis of chronic splanchnic syndrome depends mainly on a strong clinical suspicion. Usually the classical triad is incomplete or absent. Therefore chronic splanchnic syndrome should be considered, in every patient with chronic abdominal discomfort, after exclusion of other more common causes of upper abdominal discomfort. Findings from nonvasive and invasive diagnostic tests support the presence of chronic splanchnic syndrome. However, until now, the diagnosis of chronic splanchnic syndrome has usually only been made retrospectively if all the symptoms disappeared after technically successful reconstructive surgery. A variety of surgical techniques has been advocated to repair the splanchnic arteries. The choice of the technique is usually based on the preference and experience of the surgeon.     

Prolonged mivacurium infusion in young and elderly adults

PURPOSE: This study was designed to evaluate pharmacodynamically and pharmacokinetically if the cis-cis isomer of mivacurium contributed to neuromuscular block during prolonged infusions lasting more than four hours in young adult and elderly (> 60 yr) patients. METHODS: The mechanomyogramic neuromuscular response of the adductor pollicis was recorded in 32 adults 18-59 yr. and 19 elderly (> 60 yr.) patients during N2O:O2:opioid anaesthesia. The mivacurium infusion rate was adjusted to maintain single twitch depression at 95 +/- 4% of control. Blood samples were taken every 30 min to determine the plasma concentration of cis-cis isomer of mivacurium. At the end of the surgical procedure, patients were allowed to recover spontaneously to at least 25% of control twitch response. RESULTS: The mean mivacurium infusion requirement to maintain 97 +/- 1 (mean +/- SD)% depression of the twitch response was 6.0 +/- 0.4 micrograms.kg-1.min-1 in young adults, and 4.3 +/- 0.3 micrograms.kg-1.min-1 in elderly patients (P < 0.001). The infusion requirement in patients with low plasma cholinesterase activity was the lowest 2.4 +/- 1.2 micrograms.kg-1.min-1. Plasma cis-cis isomer concentrations reached peak levels within one-two hours and remained relatively constant throughout the duration of infusion even in patients with low cholinesterase activity. There was no relationship between duration of infusion, plasma concentrations of cis-cis isomer and the early recovery indices of mivacurium (up to 25%). Neuromuscular transmission recovered adequately with or without antagonism in all patients. CONCLUSION: When the mivacurium infusion was titrated to maintain 95 +/- 4% twitch depression, the plasma concentration of the cis-cis isomer did not increase during prolonged infusions (four hours) and neuromuscular transmission recovers satisfactorily.     

Identifying comorbid depression in elderly medical patients: Use of the Extracted Hamilton Depression Rating Scale.

The high prevalence and low rate of detection of comorbid depression in primary care is now well documented. Older adults with multiple medical problems represent a population at higher risk for underrecognition. The Extracted Hamilton Depression Rating Scale (XHDRS) was evaluated as a screening instrument for depression diagnosed according to Research Diagnostic Criteria in a sample of 150 geriatric medical and surgical inpatients. Scale reliability and validity were evaluated, and its sensitivity, specificity, and predictive power were calculated at multiple cutoff points. Results indicated good internal consistency, interrater reliability, concurrent validity, convergent validity, and discriminant validity. Additionally, use of the XHDRS offered greatly improved case identification when compared with use of conventional screening procedures. The XHDRS also showed improved specificity and positive predictive power when compared with several widely used self-report symptom scales. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Depression among cancer patients

OBJECTIVE: To identify important causes of premature mortality among Aboriginal adults in the Northern Territory (NT), 1979-1991. METHODS: All deaths of NT Aboriginal residents aged 15-64 years which occurred in the NT between 1979 and 1991 and which were recorded by the Registry of Births, Deaths and Marriages were included. Standardised mortality ratios (SMRs) were used to compare the number of deaths observed among Aboriginals in the NT to those expected, based on overall Australian rates. Years of potential life lost before age 65 (YPLL65) were estimated for specific causes of death. RESULTS: Aboriginal women (overall SMR, 5.5) and Aboriginal men (SMR, 4.7) experienced a high burden of excess mortality from almost every cause of death. This excess increased over time, especially for Aboriginal women. Among Aboriginal men, the most important causes of premature death were motor vehicle accidents (11% of excess deaths and 17% of YPLL65), ischaemic heart disease (10% of excess deaths and 10% of YPLL65), pneumonia and influenza (8% of excess deaths and 6% of YPLL65), and homicide (7% of excess deaths and 8% of YPLL65). For Aboriginal women, the most important causes included homicide (7% of excess deaths and 11% of YPLL65), chronic obstructive pulmonary disease (10% of excess deaths and 5% of YPLL65), rheumatic heart disease (7% of excess deaths and 8% of YPLL65), and ischaemic heart disease (6% of excess deaths and 5% of YPLL65). CONCLUSIONS: The wide variety of causes of excess mortality will require an equally wide variety of solutions, both medical and non-medical, and a long term commitment will be necessary to achieve reductions in premature mortality among NT Aboriginal adults.     

Recognition of multiply degraded speech by young and elderly listeners

This study investigated the hypothesis that age effects exert an increased influence on speech recognition performance as the number of acoustic degradations of the speech signal increases. Four groups participated: young listeners with normal hearing, elderly listeners with normal hearing, young listeners with hearing loss, and elderly listeners with hearing loss. Recognition was assessed for sentence materials degraded by noise, reverberation, or time compression, either in isolation or in binary combinations. Performance scores were converted to an equivalent signal-to-noise ratio index to facilitate direct comparison of the effects of different forms of stimulus degradation. Age effects were observed primarily in multiple degradation conditions featuring time compression of the stimuli. These results are discussed in terms of a postulated change in functional signal-to-noise ratio with increasing age.     

Depression among elderly Chinese immigrants: an exploratory study

Despite an increase in the population of elderly Chinese immigrants, little is known about their mental health problems. The most prevalent mental health problem of elderly people-depression-often goes unrecognized and untreated. In an interview format, the author administered the Geriatric Depression Scale and measures of health status, living situation, stressful life events, and informal support to a community sample of 50 elderly Chinese immigrants recruited at senior centers and meal sites. Respondents who rated their health as good, who lived with others, and who were satisfied with help received from family members were least likely to be depressed. The impact of these factors on the mental health of elderly Chinese immigrants can be understood in light of their unique cultural values.     

Haemodynamic and renal effects of felodipine in young and elderly subjects

OBJECTIVE: To study the influence of age on renal and haemodynamic effects of the calcium antagonist felodipine. METHODS: Eight young (mean age 27 years) and eight elderly (mean age 75 years) healthy normotensive subjects were given felodipine intravenously for 120 min aiming at close to therapeutic plasma level concentration. Renal blood flow (RBF) and renal vascular resistance (RVR) was estimated from para-aminohippuric acid (PAH) clearance 51CrEDTA clearance was used to measure glomerular filtration rate (GFR) and used in the calculations of fractional excretion (FE) of electrolytes. Impedance cardiography was performed to assess stroke volume and for the calculation of cardiac output and ejection fraction. RESULTS: At the end of felodipine infusion, the concentration of felodipine was on average 10.0 nmol x l(-1) in young and 12.0 nmol x l(-1) in elderly subjects (NS). During felodipine infusion blood pressure (BP) decreased from 138/76 to 120/68 in elderly subjects. The BP in young subjects was 126/74 at basal and 125/70 after infusion of felodipine. The systemic and renal vascular resistance decreased to a similar extent in young and elderly subjects after felodipine infusion. Felodipine caused a decrease in systemic vascular resistance from 25.6 to 23.3 in elderly and from 23.8 to 21.8 in the young subjects. Mean values for RVR at baseline and during infusion of felodipine were significantly higher in the elderly (10.1-15.1) than in the young subjects (5.4-6.7). Felodipine reduced RVR by 10% in the young and by 12% in the elderly at the end of infusion. The young subjects had 31% higher GFR than the elderly subjects at the start of infusion. Felodipine infusion did not affect GFR. There were no effects on stroke volume and ejection fraction. An initial natriuretic effect was found after infusion of felodipine in the young subjects. The fractional excretion of all electrolytes tended to increase after both felodipine and placebo, more in the elderly than in the young subjects. CONCLUSION: The effects of felodipine on central and renal haemodynamics previously observed in young and middle-aged subjects also seem to exist in the elderly. Volume expansion seems to increase the excretion of electrolytes more in elderly than in young people, and therefore the effect of felodipine on natriuresis is more evident in young subjects.     

Psychometric evaluation of the Geriatric Depression Scale and the Zung Self-Rating Depression Scale using an elderly community sample.

In this study the psychometric properties of the Geriatric Depression Scale (GDS) and the Zung Self-Rating Depression Scale (SDS) were evaluated and compared, using a relatively large elderly community sample. The GDS generally performed well, replicating earlier findings from a different population. Also, as hypothesized, the SDS, which has a multiple-choice format, had a higher noncompletion rate than the GDS, which has a true–false format. Finally, no significant differences between the responses of young–old and old–old subjects were observed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The perception of induced dental pain in young and elderly women

Pain threshold for electrical stimulation of healthy, unfilled teeth was studied in young and elderly women. Using the methodology of Sensory Decision Theory, ability to discriminate between suprathreshold shocks (d') and response bias were also assessed. No difference in threshold was observed betweeen the young and elderly groups. The elderly women were poorer at discriminating between suprathreshold shocks than the young women. These results were interpreted to reflect the integrity of highthreshold dental pulp afferents in the elderly and a central nervous system deficit on the part of the elderly for discriminating between such shocks. Significant age differences in response bias were also observed. Elderly subjects were biased against reporting shock as very faint pain compared to the young subjects and they restricted the range of their criteria across the six-point rating scale.     

Mental manipulation of spatial information in young and elderly adults.

Investigated the ability of 20-, 60-, and 70-yr-olds (12 men and 12 women at each age level) to mentally manipulate spatial information in a large-scale environment. In a perspective-taking task, Ss were asked to determine the location of target objects from imagined locations. In an array rotation task, Ss were asked to imagine that the array of objects rotated relative to their current position. Young and elderly Ss performed with equivalent accuracy on the array rotation task, but young Ss were more accurate on the perspective-taking task. Ss who were taken to each object location prior to testing were more accurate in the perspective-taking task than Ss who did not have this experience. There was no effect of prior experience on performance in the array rotation task. (4 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cortisol differentially affects memory in young and elderly men.

Nine young and 11 elderly men participated in this placebo-controlled, double-blind, crossover study (0.5 mg/kg cortisol or intravenous placebo). Participants learned a word list before cortisol administration, and delayed recall was then tested. A 2nd word list was learned and recalled after drug administration. In addition, the Paragraph Recall Test and tests measuring working memory (Digit Span), attention (timed cancellation), and response inhibition (Stroop Color and Word Test) were administered at 2 time points after drug administration. Cortisol reduced recall from the word list learned before treatment in both groups but did not influence recall of the list learned after treatment. In contrast, Digit Span performance was decreased by cortisol in young but not elderly participants. The possibility that differential age-associated brain changes might underlie the present results is discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Body composition, nutrition and nutritional habits of young and elderly adults

After the unification of East and West Germany the living conditions and the nutritional habits of the East German population changed considerably. The effects of these changes on nutritional status, physique and body composition are examined by a comparison of the representative sample of Greil taken from the East German population before the reunification of Germany with the sample of Trippo measured in the East German town of Potsdam between 1995 and 1997. The comparison of the samples of Greil and Trippo gives no indication of any increase in overweight subjects or adiposity during the last few years amongst the older test persons. However, the body mass of younger subjects shows a slight increase. Comparison of the estimates of total body fat showed considerable variation in results for skinfold thickness measurements and bioelectrical impedance analysis depending on the formula used.     

Mechanisms mediating postprandial blood pressure reduction in young and elderly subjects

The objective of this study was to clarify potential differences in hormonal, neurogenic and hemodynamic mechanisms mediating postprandial blood pressure (BP) reduction. In 12 age- and body mass index-matched young normotensive (NT) subjects, 21 elderly NT, 17 young hypertensive (EH) patients, and 32 elderly EH, we measured BP, blood glucose, plasma insulin (IRI), and norepinephrine (NE) levels before and every 30 min for 3 h after a 75 g oral glucose solution ingestion. Cardiac output (CO) and total systemic resistance (TSR) were also measured before and 1 h after oral glucose ingestion. Postprandial BP reduction, defined as 10% or more decline in mean BP was recognized in 3/12 (25%) young NT, 9/21 (43%) elderly NT, 5/17 (29%) young EH, and 20/32 (63%) elderly EH. The most consistent finding was that the IRI response to glucose was high in all subjects with postprandial BP reduction regardless of age or level of BP, although changes in blood glucose levels showed no major differences. The NE level was low in young and elderly NT with postprandial BP reduction, but in EH the level was not different. Increases in CO in elderly subjects with postprandial BP reduction was significantly less than that in subjects without postprandial BP reduction. In addition, the decrease in TSR in young subjects with postprandial BP reduction was significantly greater than that in subjects without postprandial BP reduction, while the decrease in elderly subjects was not different between the subjects with and without postprandial BP reduction. In conclusion, postprandial BP reduction in elderly EH appears to be associated with hyperinsulinemia independent of age and BP status. The vasodilator effects of insulin may contribute to postprandial BP reduction. A second conclusion is that impairment of sympathetic nervous system responses to insulin may also contribute to altered postprandial hemodynamic responses especially in EH, suggesting multiple mechanisms in origin of postprandial BP reduction.     

Depression screening scale validation in an elderly, community-dwelling population.

This study contrasted the relative effectiveness of an interviewer-rated instrument, the Hamilton Depression Rating Scale, and 2 self-report scales, the short form of the Beck Depression Inventory and the depression scale from the Brief Symptom Inventory, in identifying cases of depression. Cases of major depression, dysthymia, and depressive disorder not otherwise specified (NOS) were identified by means of the Structured Clinical Interview for DSM-III—R (SCID) in a sample of 177 elderly community-dwellers. Receiver operating curves were used to evaluate the relative abilities of the 3 screening instruments to identify cases of depression. All 3 instruments identified major depression and depressive disorder NOS. None was consistently sensitive to cases of dysthymia. The incremental utility of the interview-based instrument for screening was nonsignificant, suggesting that the increased expense in a community setting may not be justified. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Measures of postural steadiness: differences between healthy young and elderly adults

Measures of postural steadiness are used to characterize the dynamics of the postural control system associated with maintaining balance during quiet standing. The objective of this study was to evaluate the relative sensitivity of center-of-pressure (COP)-based measures to changes in postural steadiness related to age. A variety of time and frequency domain measures of postural steadiness were compared between a group of twenty healthy young adults (21-35 years) and a group of twenty healthy elderly adults (66-70 years) under both eyes-open and eyes-closed conditions. The measures that identified differences between the eyes-open and eyes-closed conditions in the young adult group were different than those that identified differences between the eye conditions in the elderly adult group. Mean velocity of the COP was the only measure that identified age-related changes in both eye conditions, and differences between eye conditions in both groups. The results of this study will be useful to researchers and clinicians using COP-based measures to evaluate postural steadiness.     

Radiotherapy for elderly patients

Fifty-seven revision total hip arthroplasties in fifty-six patients were performed with a Harris-Galante porous-coated acetabular component by one surgeon, and the patients were followed prospectively for a mean of seven years (range, five to twelve years). A trochanteric osteotomy was performed in forty hips, and a posterior approach with an extended anterior capsulectomy was used in the other seventeen. The acetabular defect was classified as segmental in seven hips, cavitary in twenty-three, and combined in twenty-one; six hips had no notable defect. A bulk allograft was used in eleven hips, and morseled cancellous-bone allograft or autogenous graft was used in thirty-four hips; twelve hips did not have bone-grafting. Both the femoral and the acetabular component were revised in forty-five hips, and only the acetabular component was revised in twelve. Thirty-nine hips (68 per cent) had a good or excellent clinical result according to the Harris hip score. The acetabular component was well fixed in the fourteen hips that had a fair result and the four hips that had a poor result. The acetabular component was considered to have migrated if there was a change in the angle of the cup of 5 degrees or more or a change in the horizontal or vertical position of the cup of more than three millimeters. Despite varying degrees of bone loss, no acetabular component had radiographic evidence of loosening at the latest follow-up examination. No component was revised and no revisions were scheduled. One hip was debrided for a late metastatic infection, but the component was well fixed and was not revised. There were no complications related to the use of screws for fixation. These mid-term results confirm the early success of acetabular revisions performed with fixation of a titanium fiber-metal-coated hemispherical component with multiple screws and no cement.