Hasil untuk "Geriatrics"

Neelu Jain Gupta, Priyanka Grover, Nisha Singh

The present study depicts differences in sleep behavior, activity, and light exposure of homemakers and office-going women of urban India using a questionnaire survey, actigraphy, and urinary melatonin assay. Self-reported surveys filled by 1316 office-going and 1393 homemaker women (ages 18–79 years) comprised 7 brief questions, viz. body mass index (BMI), work-hours, sleep characteristics etc. We predicted that differences in sleep timings and daily activity patterns of urban Indian women were related to occupational routines, specifically among office-going and homemaker women. Results suggested associativity and relative risk for altered sleep length and recreation with age and occupation. Sleep onset in young and old office-going women was delayed, not in the middle-aged. Objective measurement of sleep, daily activity, and light exposure suggested disrupted Sunday activity than weekdays. Externally managed work-rest cycles in office-goers during weekdays consolidated daily activity patterns. During weekdays, homemakers exhibited greater intraday activity variability. Photometric luminance data using actigraphy revealed homemakers experienced greater exposure to brighter morning light intensities compared to office-going women, although urinary melatonin levels did not differ among groups. The variation in associativity of light-activity during weekdays depicted better light-activity coupling in homemakers. Our observation of delayed sleep onset, in office-goers needs attention because it is an established risk factor to various lifestyle disorders.. Using multimodal methodology of subjective and objective measures, our study validates age-related sleep onset timing, a hidden factor in contemporary health issues.

Kuntal Godde, Shubhangi P. Raut, Rishikesh Rokde et al.

Parkinson’s disease (PD) is a neurodegenerative disorder influenced by multiple factors and primarily defined by the gradual loss of dopaminergic neurons within the substantia nigra pars compacta. This pathological process fundamentally reduces available dopamine levels and produces core motor symptoms that include bradykinesia, resting tremor, rigidity, postural instability, and a generalized loss of balance. However, the pathology of PD appears to include far more than nigrostriatal function, as it is increasingly recognized that PD extends across the central and peripheral nervous systems through many different neurotransmitter systems/neurotransmitters, neuroinflammation, mitochondrial dysfunction, genetic mutations, abnormal protein aggregation (particularly of α-synuclein), and other factors. Thus, the complexities of PD are suggestive of more of a syndromic process rather than a single disease process with varied pathogenetic pathways that also result in varied clinical presentations. Traditionally, treatment options for PD have primarily focused on dopaminergic treatment strategies to manage the progressive symptoms, which include the lifestyle impact of diminished dopamine levels. This regimen primarily includes levodopa in addition to dopamine agonist options and an array of adjunctive therapies. While these early treatments are completely life-altering and provide considerable improvement for the first several years, their benefit eventually wanes, and they fundamentally simply do not alter disease progression. Recently, there has been a concerted effort to identify treatment options that are not simply a dopaminergic replacement treatment but can alter some aspects of the disease, including several novel approaches investigating mitochondrial health, neuroinflammation, autophagy, α-synuclein aggregation, and genetic regulation in both preclinical and early clinical studies. This review takes a critical look at the classic view of PD occurring as a result of dopaminergic dysfunction, extends into modern concepts that include abnormalities at the cellular and molecular levels, and describes new treatment strategies that fundamentally reflect the multifactorial nature of PD. However, its central aim is to direct the audience to interventions that not only relieve symptoms but also hold the promise to stop or reverse the disease, ultimately offering renewed hope to patients and physicians alike.

Takayuki Kodama, Masahiro Yoshikawa, Kosuke Minamii et al.

Background: Self-controlled motor imagery combined with assistive devices is promising for enhancing neurorehabilitation. This study developed a soft, Flexible Exoskeleton (flexEXO) for finger movements and investigated whether self-controlled motor tasks facilitate stronger cortical activation than externally controlled conditions. Methods: Twenty-one healthy participants performed grasping tasks under four conditions: Self-Controlled Motion (SCC), Other-Controlled Motion (OCC), Self-Controlled Imagery Only (SCIOC), and Other-Controlled Imagery Only (OCIOC). EEG data were recorded, focusing on event-related desynchronization (ERD) in the μ and β bands during imagery and motion and event-related synchronization (ERS) in the β band during feedback. Source localization was performed using eLORETA. Results: Higher μERD and βERD were observed during self-controlled tasks, particularly in the primary motor cortex and supplementary motor area. Externally controlled tasks showed enhanced activation in the inferior parietal lobule and secondary somatosensory cortex. βERS did not differ significantly across conditions. Source localization revealed that self-controlled tasks engaged motor planning and error-monitoring regions more robustly. Conclusions: The flexEXO device and the comparison of brain activity under different conditions provide insights into the neural mechanisms of motor control and have implications for neurorehabilitation.

Yuchao Chen, Jie Zhou, Zhouyao Hu et al.

Background: Repetitive transcranial magnetic stimulation (rTMS) over the cerebellum has shown therapeutic potential for spinocerebellar ataxia type 3 (SCA3). However, the underlying electrophysiological mechanisms remain unclear. Here, we aimed to utilize single-pulse TMS combined with electroencephalography co-registration (TMS-EEG) to probe cerebellar projections underlying the effects of rTMS in SCA3 patients. Methods: A group of 38 SCA3 patients and 35 healthy controls underwent baseline TMS-EEG to assess cerebellar projections. Patients were evaluated using the International Cooperative Ataxia Rating Scale (ICARS) and then randomized to receive either a 3-week course of active intermittent theta burst stimulation (iTBS) or sham iTBS applied to the cerebellum. ICARS assessments were then performed at post-treatment and 3-month follow-up, with additional TMS-EEG performed post-treatment. Results: ICARS scores were improved by iTBS treatment than the Sham stimulation at post-treatment (2.67 [95 %CI, 0.53–4.81]; p = 0.016) and 3-month follow-up (4.11 [95 %CI, 1.02–7.20]; p = 0.011). iTBS restored cerebello-cortical inhibition over the contralateral motor cortex as reflected by enhanced N45 amplitude (1.31 [95 %CI, 0.08–2.53]; p = 0.038), which covaried with better clinical improvement (p = 0.005). iTBS also reorganized beta band oscillation, that potentially underlies the cerebello-cortical inhibition in SCA3 individuals. At the source level, cerebellar rTMS normalized the impaired cerebello-cortical inhibition characterized by the evoked current density over the motor cortex. Conclusions: Our findings indicate that cerebellar iTBS alleviates clinical ataxia severity in SCA3 potentially by restoring cerebello-cortical inhibition and reorganizing beta-band activity. N45 amplitude may serve as a potential biomarker for treatment response in SCA3.

Philip Cole Brewer, Timi Kehinde Ojo, Killian Joseph Bucci et al.

Background: The objective of this study is to identify risk factors that contribute to sex differences in Alzheimer dementia (AD) patients that also present with irritability and anger (ADIA) and determine whether these factors are different between male and female patients with ADIA. Method: We used data from the of database for AD with a history of irritability and collected from a large academic center from 2016 to 2020. A total of 128,769 patients with AD were identified: 72,896 females and 55,873 males. Univariate was used to stratified risk factors base on sex and presence or absence of anger and irritability among AD patients. The adjusted odds ratios (ORs) and 95 % confidence intervals (CIs) for each risk factor or demographic were used to predict the odds of a specific risk factors being associated with male or female ADIA. Result: In the adjusted analysis, male ADIA patients were more likely to present with hypertension (OR = 2.894, 95 % CI, 2.079–4.028), insomnia (OR = 1.736, 95 % CI, 1.132–2.663), dyslipidemia (OR = 1.974, 95 % CI, 1.119–3.482), and peripheral vascular disease (OR = 44.135, 95 % CI, 4.344–448.364). Females were more likely to present with osteoporosis (OR = 0.002, 95 % CI, 0.001–0.023), gait dysfunction (OR = 0.034, 95 % CI, 0.003–0.452), anxiety (OR = 0.634, 95 % CI, 0.472–0.852), urinary tract infection (OR = 0.157, 95 % CI, 0.063–0.393), headaches (OR = 0.121, 95 % CI, 0.052–0.282) and pneumonia (OR = 0.209, 95 % CI, 0.114–0.384). Conclusion: This study reveals key sex differences in ADIA patients. A population-based approach that tackles inequalities in risk factors may offer population-based healthcare and care of male and female ADIA patients.

Weslley Barbosa Sales, Eunice Fernandes Maranhão, Caroline Sousa Truta Ramalho et al.

Abstract Introduction Certain situations and contexts during early years of life and childhood can have a significant impact on the health of older individuals. Studies have demonstrated that adversities such as poverty, neglect, abuse, and exposure to chronic stress conditions during the early years of life are associated with a range of health problems in adulthood. Objective To systematically identify the literature on the impact of circumstances and/or conditions in early life/childhood on the health of older adults. Materials and methods A systematic literature review guided by the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) was conducted. The databases used were PUBMED, LILACS, Scielo, Embase, and Web of Science. Longitudinal studies published without language or publication date restrictions, related to the proposed theme, were included. Editorial letters, review protocols, reflective studies, literature reviews, and articles without available online abstracts or full texts were excluded. The quality assessment of the studies was conducted using tools and guidelines provided by the Joanna Briggs Institute. The database search conducted between May and August 2023 resulted in 8,224 articles found. After completing the steps of duplicate exclusion and reading titles and abstracts, 35 articles were selected for full reading, culminating in a final sample of 10 eligible articles for this review. Results These studies highlighted various early-life circumstances, including socioeconomic status, exposure to adverse childhood experiences, and environmental factors, demonstrating significant associations with health outcomes in older adults. The findings collectively emphasize the critical role that early adversities play in influencing chronic diseases, mental health, and overall well-being in later life. Final considerations Understanding social determinants, early-life adversities, and socioeconomic factors is essential for promoting healthy and equitable aging, with effective interventions and public policies aimed at reducing inequalities and ensuring the well-being of the adults and older adults.

Nora Helena Galvan Gomes, Newton Luis Terra

Objetivo: Avaliar a influência da prótese auditiva na qualidade de vida e na audição em idosos com deficiência auditiva. Métodos: Participaram do estudo 50 idosos, sendo 29 do sexo feminino e 21 do sexo masculino, com idade igual ou superior a 60 anos. Divididos em 2 grupos – G1 – Grupo de Intervenção e o G2 – Grupo Controle. Foram aplicados os testes Hearing Handcap Inventory for the Elderly – Screening Version (HHIE- -S), Miniexame do Estado Mental (MEEM) e World Health Organization Quality of Life Instruments (WHOQOL-BREF) antes do uso das próteses auditivas e 12 semanas após. Resultados: Foi observada melhora significativa na análise dos escores do HHIE-s no período após o uso das próteses auditivas – G1. A análise do MEEM apresentou diferenças estatisticamente significantes, comparando os 2 grupos. No teste WHOQOL-BREF a qualidade de vida apresentou diferença apenas no domínio físico, comparando com idosos que não fizeram uso de amplificação auditiva. Conclusão: Através de questionários de autoavaliação, foi possível confirmar os benefícios do uso de próteses auditivas, pois houve uma diminuição na percepção do usuário da própria incapacidade auditiva.

Lu P, Wang T, Wan Z et al.

Peng Lu,1,2,* Tun Wang,1,2,* Zicheng Wan,1,2 Mo Wang,1,2 Yang Zhou,1,2 Zhenyu He,1,2 Sheng Liao,1,2 Haiyang Liu,3 Chang Shu1,2,4 1Department of Vascular Surgery, the Second Xiangya Hospital, Central South University, Changsha, People’s Republic of China; 2Institute of Vascular Diseases, Central South University, Changsha, People’s Republic of China; 3Department of Geriatrics, the Second Xiangya Hospital, Central South University, Changsha, People’s Republic of China; 4Center of Vascular Surgery, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, People’s Republic of China*These authors contributed equally to this workCorrespondence: Chang Shu, Department of Vascular Surgery, the Second Xiangya Hospital, Central South University, Changsha, People’s Republic of China, Tel +86 136 0744 4222, Email Shuchang@csu.edu.cnPurpose: Arteriovenous fistula (AVF) is the preferred vascular access for hemodialysis, but the low maturation rate is concerning. Immune cells’ impact on AVF maturation lacks bioinformatics research. The study aims to investigate the potential predictive role of immune-related genes and immune cell infiltration characteristics in AVF maturation.Patients and Methods: We analyzed the high-throughput sequencing dataset to identify differentially expressed genes (DEGs). Then, we performed enrichment analyses (GO, KEGG, GSEA) on immune-related genes and pathways in mature AVF. We focused on differentially expressed immune-related genes (DEIRGs) and constructed a PPI network to identify hub genes. These hub genes were validated in other databases and experiments, including qPCR and immunohistochemistry (IHC). The immune cell infiltration characteristics in native veins, failed AVFs, and matured AVFs were analyzed by cibersortX. Partial experimental validation was conducted using clinical samples.Results: Our results showed that immune-related genes and signaling pathways are significantly enriched in mature AVF. We validated this in other databases and ultimately identified three hub genes (IL1B, IL6, CXCR4) in combination with experiments. Significant differences in immune cell infiltration characteristics were observed among native veins, failed AVFs, and matured AVFs. Immune cell infiltration analysis revealed that accumulation of CD4+ T cells, dendritic cells, mast cells and M2 macrophages contribute to AVF maturation. These immune-related genes and immune cells have the potential to serve as predictive factors for AVF maturation. We partially validated this experimentally.Conclusion: From a bioinformatics perspective, our results have identified, for the first time, a set of immune-related genes and immune cell infiltration features that can characterize the maturation of AVF and significantly impact AVF maturation. These features hold potential as predictive indicators for AVF maturation outcomes.Keywords: AVF maturation, bioinformatics, immune-related genes, inflammation

Michael Ssonko, Anneli Hardy, Vasi Naganathan et al.

Abstract Background There are no published longitudinal studies from Africa of people with dementia seen in memory clinics. The aim of this study was to determine the proportions of the different dementia subtypes, rates of cognitive decline, and predictors of survival in patients diagnosed with dementia and seen in a memory clinic. Methods Data were collected retrospectively from clinic records of patients aged ≥ 60 seen in the memory clinic at Groote Schuur Hospital, Cape Town, South Africa over a 10-year period. Diagnostic and Statistical Manual of Mental Disorders (DSM–5) criteria were used to identify patients with Major Neurocognitive Disorders (dementia). Additional diagnostic criteria were used to determine the specific subtypes of dementia. Linear regression analysis was used to determine crude rates of cognitive decline, expressed as mini-mental state examination (MMSE) points lost per year. Changes in MMSE scores were derived using mixed effects modelling to curvilinear models of cognitive change, with time as the dependent variable. Multivariable cox survival analysis was used to determine factors at baseline that predicted mortality. Results Of the 165 patients who met inclusion criteria, 117(70.9%) had Major Neurocognitive Disorder due to Alzheimer’s disease (AD), 24(14.6%) Vascular Neurocognitive Disorder (VND), 6(3.6%) Dementia with Lewy Bodies (DLB), 5(3%) Parkinson disease-associated dementia (PDD), 3(1.8%) fronto-temporal dementia, 4(2.4%) mixed dementia and 6(3.6%) other types of dementia. The average annual decline in MMSE points was 2.2(DLB/PDD), 2.1(AD) and 1.3(VND). Cognitive scores at baseline were significantly lower in patients with 8 compared to 13 years of education and in those with VND compared with AD. Factors associated with shorter survival included age at onset greater than 65 (HR = 1.82, 95% C.I. 1.11, 2.99, p = 0.017), lower baseline MMSE (HR = 1.05, 95% C.I. 1.01, 1.10, p = 0.029), Charlson’s comorbidity scores of 3 to 4 (HR = 1.88, 95% C.I. 1.14, 3.10, p = 0.014), scores of 5 or more (HR = 1.97, 95% C.I. 1.16, 3.34, p = 0.012) and DLB/PDD (HR = 3.07, 95% C.I. 1.50, 6.29, p = 0.002). Being female (HR = 0.59, 95% C.I.0.36, 0.95, p = 0.029) was associated with longer survival. Conclusions Knowledge of dementia subtypes, the rate and factors affecting cognitive decline and survival outcomes will help inform decisions about patient selection for potential future therapies and for planning dementia services in resource-poor settings.

Robyn Coman, Carlo Caponecchia

Introduction: This study aimed to evaluate the suitability and usability of the Pro-Mobility patient/person handling assessment tool (ProMob) within residential aged care. Physiological changes associated with ageing influence an older person’s ability to perform functional mobility tasks such as transferring from furniture and walking. Strategies that improve capability and/or reduce the physical demands of the task have the potential to promote an older person’s mobility, independence and wellbeing. Environment-related strategies in Manual Handling of People (MHP), such as optimum seated heights, in part address this challenge, as they can promote resident functional mobility while also protecting staff from injury. The ProMob tool was developed to address this issue through systematic evaluation of these environmental factors.Methods: The participants in this study were seven (7) residential aged care facilities (RACFs) operated by a not-for-profit aged care organization. A qualified assessor evaluated MHP risk management with the ProMob tool at each RACF through collection of data for a random sample of residents (n = 67) regarding their living environments and available mobility information. Data was transferred to an SPSS-22 statistical software database for analysis which involved descriptive statistics and cross tabulations.Results: Application of the ProMob tool provided effective quantification of the nature and extent of environment-related MHP interventions that may influence resident mobility. Areas for improvement with MHP risk management were identified, with variation evident across RACF’s within the same organisation, which was not consistent with levels of care (e.g., lack of clear space to facilitate mobility). Low level care facilities were observed to have fewer adaptive environmental features that could potentially slow decline in independence.Discussion: Features of the aged care environment can be used to facilitate the functional mobility of aged care residents, and simultaneously reduce injury risk for staff in MHP interactions. The ProMob tool can be used for auditing care facilities, planning re-development, and continual improvement in provision of care and management of staff injury risk exposure.

Juan Du, Yan Ma, Hongmei Lang et al.

Abstract Objective We examined the association between nonalcoholic fatty liver disease and lumbar spine bone mineral density in individuals with and without type 2 diabetes. Methods The lumbar BMD of 1088 subjects was measured using dual-energy X-ray absorptiometry (DXA). Liver fat content was quantified via B-mode ultrasound. Multivariable linear regression was used to study the association between NAFLD and lumbar BMD in participants with and without T2DM. Results The lumbar BMD in the T2DM group and the non-diabetes group was higher in the NAFLD group than in the non-NAFLD group (P < 0.001). Multivariate regression analysis in the T2DM group showed that after adjusting for confounders, the positive association between lumbar spine BMD and NAFLD remained (P = 0.027). In the non-diabetes group, after adjusting for confounders, the association between NAFLD and lumbar spine BMD disappeared. Conclusions The relationship between nonalcoholic fatty liver disease and lumbar bone mineral density may differ in individuals with and without diabetes. The effect of nonalcoholic fatty liver disease on bone mineral density needs to be evaluated in different clinical contexts.

Hui Hua, Hongying Zhang, Jingzhu Chen et al.

Abstract Biomarkers-guided precision therapeutics has revolutionized the clinical development and administration of molecular-targeted anticancer agents. Tailored precision cancer therapy exhibits better response rate compared to unselective treatment. Protein kinases have critical roles in cell signaling, metabolism, proliferation, survival and migration. Aberrant activation of protein kinases is critical for tumor growth and progression. Hence, protein kinases are key targets for molecular targeted cancer therapy. The serine/threonine kinase Akt is frequently activated in various types of cancer. Activation of Akt promotes tumor progression and drug resistance. Since the first Akt inhibitor was reported in 2000, many Akt inhibitors have been developed and evaluated in either early or late stage of clinical trials, which take advantage of liquid biopsy and genomic or molecular profiling to realize personalized cancer therapy. Two inhibitors, capivasertib and ipatasertib, are being tested in phase III clinical trials for cancer therapy. Here, we highlight recent progress of Akt signaling pathway, review the up-to-date data from clinical studies of Akt inhibitors and discuss the potential biomarkers that may help personalized treatment of cancer with Akt inhibitors. In addition, we also discuss how Akt may confer the vulnerability of cancer cells to some kinds of anticancer agents.

Sid E. O'Bryant, Fan Zhang, Wayne Silverman et al.

Abstract Introduction We sought to determine if proteomic profiles could predict risk for incident mild cognitive impairment (MCI) and Alzheimer's disease (AD) among adults with Down syndrome (DS). Methods In a cohort of 398 adults with DS, a total of n = 186 participants were determined to be non‐demented and without MCI or AD at baseline and throughout follow‐up; n = 103 had incident MCI and n = 81 had incident AD. Proteomics were conducted on banked plasma samples from a previously generated algorithm. Results The proteomic profile was highly accurate in predicting incident MCI (area under the curve [AUC] = 0.92) and incident AD (AUC = 0.88). For MCI risk, the support vector machine (SVM)‐based high/low cut‐point yielded an adjusted hazard ratio (HR) = 6.46 (P < .001). For AD risk, the SVM‐based high/low cut‐point score yielded an adjusted HR = 8.4 (P < .001). Discussion The current results provide support for our blood‐based proteomic profile for predicting risk for MCI and AD among adults with DS.

Michael R. Wasserman

This letter comments on the article by David Reuben .

Kerstin Bitter, Christina Pehe, Manfred Krüger et al.

Abstract Background The benefit of medication reviews for long-term care (LTC) residents has been generally recognized throughout health care systems. Whereas many studies showed the impact of comprehensive medication reviews performed by specialized clinical pharmacists, little is known about the impact of medication reviews performed by community pharmacists. Involving them in the provision of medication reviews may help satisfy the increasing demand for ensuring medication safety. Methods Community pharmacists supplying drugs to the LTC facilities performed a medication review for German LTC residents aged at least 65 years and taking five or more drugs per day based on the patients’ medication only. Documented potential drug-related problems (DRPs) and the implementation rate of pharmaceutical interventions were evaluated descriptively. To assess the quality of the medication reviews, we developed a corresponding reference system based on the analysis of two experienced clinical pharmacists. Results Twelve pharmacies performed medication reviews for 94 LTC residents. Overall, the pharmacists documented 154 potential DRPs (mean 1.6 per patient, SD 1.5) of which the most common were drug-drug interactions (40%) followed by potentially inappropriate medication (PIM) (16%) and inappropriate dosages (14%). 33% of the pharmacists’ interventions to solve DRPs were successfully implemented, mostly dosage adjustments. The identification of potentially severe drug-drug interactions and PIM showed the highest agreement (88 and 73%) with the reference system. Conclusions The medication review program of community pharmacists for LTC residents led to the identification of relevant DRPs. The reference system assessing the quality of the service can contribute to its transparency and reveals the potential for its improvement. The community pharmacists’ knowledge of the LTC residents and their relation to the prescribers is crucial for providing successful medication reviews.

Rita de Cassia Cabral de Campos Martins, Sidnei José Casetto, Ricardo Luís Fernandes Guerra

Abstract Objectives: The aim of the present qualitative and quantitative study was to investigate whether the participation of elderly persons in the University of the Third Age (U3A) of the Federal University of São Paulo, Baixada Santista (Unifesp/BS) led to a perceived improvement in quality of life; the meaning of the term quality of life for the participants; and whether education and social interaction are considered relevant in any such perceived improvement. Method: Data were collected through the SF-36 questionnaire and semi-structured interviews at the beginning and end of the academic year. Results: The quantitative data did not differ significantly between the beginning and end of the research period, except for the variable Vitality (V). The qualitative results, however, signaled a perception of change in terms of education, social interaction and quality of life. Conclusion: The data indicated that participation in the University of the Third Age at the Federal University of São Paulo, Baixada Santista (Unifesp/BS) was associated with a perception of positive changes in the quality of life of the elderly persons, who considered social interaction and education to be an important part of these improvements.

Stefan Dörr, Gregor Weisser, Ralf Lobmann

Chronic wounds are common in elderly patients, and the majority of them are caused by vascular diseases, such as peripheral arterial occlusive disease (PAD) or chronic venous insufficiency. Because of typical signs, these diseases can be usually easily differentiated. However, 10% of chronic wounds are caused by specific rare diseases, such as vasculitis, specific infections, skin cancer, or calciphylaxis. Calciphylaxis is a rare cause of chronic wounds, and it is usually found in patients with end-stage renal disease. In this paper, we describe the case of an 83-year-old woman with a chronic ulcer of the lower leg caused by calciphylaxis.

Jun Song, Chuan Wang, Aixia Ma et al.

Abstract Aims/Introduction To investigate the correlation between snoring and chronic kidney disease (CKD), and explore whether metabolic syndrome (MetS) plays an important role in this relationship among middle‐aged and elderly Chinese. Materials and Methods The participants included in the present study were categorized into three subgroups based on self‐reported snoring frequency (regularly [≥3 times per week], occasionally [between ‘regularly’ and ‘never’] or never [<1 time per month]). An estimated glomerular filtration rate <60 mL/min/1.73 m2 was considered as CKD. We diagnosed MetS based on the 2004 Chinese Diabetes Society criteria. We explored the relationship between snoring and CKD by using multiple logistic regressions. Results The frequency of MetS, MetS components and CKD was dramatically higher in regular snorers than in non‐snorers and occasional snorers. The odds ratios for MetS and all the MetS elements, except for hyperglycemia, increased progressively with the snoring frequency (P < 0.001). Upon additional adjustment for other MetS components, snoring was not significantly related with hypertension; however, the associations between snoring frequency and overweight/obesity and dyslipidemia became attenuated, but still remained statistically significant (P < 0.01). Interestingly, odds ratios for CKD also increasingly augmented with snoring frequency (P < 0.001). Upon further adjustment for individual MetS components or MetS, regular snoring also resulted in a significantly increased odds ratio for CKD (odds ratio 1.72; P = 0.034) relative to non‐snoring. Conclusions Self‐reported snoring is closely associated with CKD independent of MetS among middle‐aged and elderly Chinese.

Bence György, Camilla Lööv, Mikołaj P. Zaborowski et al.

The APPswe (Swedish) mutation in the amyloid precursor protein (APP) gene causes dominantly inherited Alzheimer’s disease (AD) as a result of increased β-secretase cleavage of the amyloid-β (Aβ) precursor protein. This leads to abnormally high Aβ levels, not only in brain but also in peripheral tissues of mutation carriers. Here, we selectively disrupted the human mutant APPSW allele using CRISPR. By applying CRISPR/Cas9 from Streptococcus pyogenes, we generated allele-specific deletions of either APPSW or APPWT. As measured by ELISA, conditioned media of targeted patient-derived fibroblasts displayed an approximate 60% reduction in secreted Aβ. Next, coding sequences for the APPSW-specific guide RNA (gRNA) and Cas9 were packaged into separate adeno-associated viral (AAV) vectors. Site-specific indel formation was achieved both in primary neurons isolated from APPSW transgenic mouse embryos (Tg2576) and after co-injection of these vectors into hippocampus of adult mice. Taken together, we here present proof-of-concept data that CRISPR/Cas9 can selectively disrupt the APPSW allele both ex vivo and in vivo—and thereby decrease pathogenic Aβ. Hence, this system may have the potential to be developed as a tool for gene therapy against AD caused by APPswe and other point mutations associated with increased Aβ.

Michael Fossel

All of us are intuitively aware, and many of us explicitly aware as well, of the meaning of geriatrics as a specialty. After all, most of us practice geriatrics or we have been intimately involved with this area and we are know the reality of geriatrics. Or do we? Geriatrics is an oddly ill-defined specialty when you look at it more carefully. Some of us practice medicine, some of us practice in the social sciences, and many of us simply do our jobs day-to-day and try to get by. What we share, however, is the heart of geriatrics: not simply a willingness, but a passion to help others who are aging. Nor is it simply “aging” in the chronological sense, but rather it is what happens as we age. It is what distinguishes the young newly-adult from the aging older-adult. In keeping with this distinction, our passion is not directed at aging as chronology, but at aging as suffering, fear, pain, disability, and the myriad other problems that arise with increasing frequency as the years grow longer. It’s not the years, it the miles.