Phenotypic and Clinical Traits That Correlate with Cognitive Impairment in Caucasian Females.

Background: Dementia affects more women than men. This suggests sex steroid-dependent structural and functional differences between male and female brains. Natural and iatrogenic changes to women's reproductive health may correlate with risk for dementia. Objective: To identify surrogate markers of key transitions within the reproductive axis that could correlate with dementia pathology in women. Specific Research Question: Could examination of the reproductive axis from birth to senescence expand our understanding of the gender predominance of dementia in women? Proxy measurements for fetal origins, reproduction, and age-related effects on estrogen-dependent tissues were collected to study dementia risk in women. Methods: Deidentified data were collected from 289 older Caucasian female patients from an out-patient clinic in Kansas City, Missouri. Women patients 65 years and older were offered the opportunity to join the study and written consent was obtained from all participants. Data were collected from 2017 to 2019. Results: Our subjects ranged in age from 65 to 98 years old, with a mean of 76 years old. Spearman correlation analysis showed significant correlation between dementia status and age (r = 0.219, p = 0.000), Fitzpatrick skin phototype (r = -0.141, p = 0.019), birth order (r = 0.151, p = 0.028), current height as measured in the office (r = -0.215, p = 0.001), and maximum height per patient recall (r = -0.173, p = 0.005). Results from the logistic regression model show that specific predictors of risk for dementia were age (odds ratio [OR] = 1.082 [1.034-1.132]; p = 0.0007), Fitzpatrick skin phototype 1 versus 3 (OR = 8.508 [1.075-67.313]; p = 0.0227), and current height (OR = 0.766 [0.642-0.915]; p = 0.0032). Of the four variables related to fetal origins: maternal age, number of siblings, birth order, and age difference between the subject and the next older sibling, none were found to be statistically significant. Since age is a significant predictor of risk for dementia, it was included as a covariate in the aforementioned logistic regression models. Conclusions: Our results showed that dementia in Caucasian women was associated with age, lower Fitzpatrick phototype, and current height. Dementia-related pathological processes in the brain may accrue over a woman's lifetime.

Variations in preference for topical vehicles among demographic groups.

Patient satisfaction and outcomes can be optimized by identifying preferences for topical vehicles by age, gender, and ethnicity. Our study sought to identify variations in preferences for creams, lotions, and ointments among different age groups, genders, and ethnicities. Each demographic group revealed statistically significant differences in vehicle preference (P < .05).

Disease Specific to Chronic Lymphedema and Class III Obesity.

Elephantiasis nostras verrucosa (ENV) is a unique, chronic condition found in patients with obesity and chronic secondary lymphedema. It develops due to chronic inflammation and recurrent infection, most commonly on gravity-dependent sites. Progressive tissue enlargement, deformity, and disability necessitate intervention. First, clinicians should explore the etiology of patients' secondary lymphedema, as this is paramount in determining treatment for ENV. The fundamental goal is alleviating lymphatic obstruction. Our literature review of available cases of ENV elucidates Class III obesity as a factor common to all available cases of ENV. As such, weight loss is a key component of treatment. Medical management and weight loss are most effective when combined with physiologic interventions such as compression garments and decongestive physiotherapy. If surgical intervention is required, one of the mainstays of patient management is a reductive approach, aimed at removing excess adipose and fibrotic tissue to improve lymphatic patency and flow. Optimal postoperative outcomes are achieved when patients also undergo physiologic procedures to bypass obstructions and connect functioning lymphatic vessels.

Urinary aquaporin 1 and perilipin 2: Can these novel markers accurately characterize small renal masses and help guide patient management?

OBJECTIVE: To evaluate the role of urine aquaporin 1 and perilipin 2 as biomarkers adjunct to renal mass biopsy in guiding the management of patients with small renal masses. METHODS: Preoperative aquaporin 1 and perilipin 2 levels in 57 patients with small renal masses undergoing partial nephrectomy were analyzed and compared with postoperative tumor histology. An algorithm was created utilizing aquaporin 1 and perilipin 2 in conjunction with renal mass biopsy. Cut-off values were implemented to maximize biomarker sensitivity and specificity. Renal mass biopsy utilization and intervention were then compared with rates in traditional renal mass biopsy algorithms. RESULTS: All clear cell and papillary renal cell carcinomas were correctly identified and assigned to the treatment path. All benign lesions were correctly sorted to a confirmatory renal mass biopsy path. Two chromophobe masses did not have elevated aquaporin 1 and perilipin 2, and would require renal mass biopsy. Compared with protocols that call for all small renal masses to be biopsied, confirmatory renal mass biopsy could have been safely avoided in 74% of patients with elevated aquaporin 1 and perilipin 2. Compared with protocols that do not utilize renal mass biopsy, surgical intervention would have been avoided in 23% of patients with benign masses. CONCLUSIONS: Aquaporin 1 and perilipin 2 possess high sensitivity and specificity for detecting clear cell and papillary renal cell carcinoma. Use of these markers might compliment renal mass biopsy in the characterization of small renal masses.