Ten years of a geriatric oncology service at a public university cancer centre in Brazil.

The implementation of a geriatric oncology service is challenging in both high-income and low-and-middle-income countries. The Octavio Frias de Oliveira Institute of Cancer of Sao Paulo (ICESP) is a tertiary healthcare complex of the Clinics Hospital of the University of Sao Paulo Medical School and is considered a model of excellence in oncology in Latin America. The objective of this manuscript is to describe 10 years of the geriatric oncology service at ICESP and the challenges for its implementation. We performed a narrative description of the ICESP's geriatric oncology service and a general retrospective descriptive analysis of data collected from routine structured medical records of patients referred to the service from 2011 to 2021. This article highlights the different settings in which the service operates (outpatient, pre-operative and hospital follow-up). In this period, 1,700 patients were assessed for preoperative evaluation (median age 83.9, SD 4.95), 468 patients were evaluated for therapeutic decision (median age 79.4, SD 7.38), 968 in general geriatric oncology care outpatient clinics from 2012 to 2021 (median age 78.7, SD 7.91) and 1,391 inpatient evaluations. In the past 10 years, our geriatric oncology team has grown exponentially and changed its characteristics in order to adjust them to the hospital demands, raising awareness among the oncology teams about the benefit of using geriatric assessment and promoting multidisciplinary discussions.

Impact of oral health on frailty syndrome in frail older adults.

OBJECTIVE: This study aimed to correlate oral and general health in frail and non-frail older adults. METHODS: This observational study included 52 older adults, of whom 35 were frail (Frail Group), and 17 were non-frail (Non-Frail Group), according to Fried's self-reported test addressing oral health variables, number of systemic diseases, and medications in use. The geriatric oral health assessment index was used to assess the oral hygiene of the groups. RESULTS: The number of preserved teeth in dentulous older adults was significantly higher in the Non-Frail Group (p=0.048). No significant differences were observed between the two groups in the use of dental prostheses or in the detection of soft tissue lesions. Overall, 74.3% of the Frail Group had a "bad" geriatric oral health index score, which significantly differed from that of the Non-Frail Group (p=0.045). The numbers of systemic diseases and medicines used were higher in the Frail Group than in the Non-Frail Group (p<0.001), demonstrating the pathophysiological characteristics of multimorbidity and polypharmacy in frailty syndrome. CONCLUSION: The results showed a clear correlation between oral and general health conditions and frailty syndrome.

Smoking Intensity Increases Diaphragm Muscle Injury: A Clinicopathologic Study.

BACKGROUND: Studying the effects of smoking intensity is important to evaluate the risk of tobacco use on a range of illnesses, such as as sarcopenia among the elderly. Thus, this study aimed to analyze the effects of pack-years of cigarette smoking on the diaphragm muscle (DIAm) histopathology of postmortem samples. METHODS: Subjects were divided into three groups: never-smoker (n = 46); less than 30 pack-years of smoking (n = 12); and more than 30 pack-years of smoking (n = 30). Diaphragm samples were stained with Picrosirius red and hematoxylin and eosin stain for general structure. RESULTS: Participants with more than 30 pack-years of cigarette smoking had a significant increase in adipocytes, blood vessels and collagen deposit, as well as an increase in histopathological alterations. CONCLUSIONS: Pack-years of smoking was associated with DIAm injury. However, further clinicopathological studies are needed to confirm our findings.

Postmortem Brains from Subjects with Diabetes Mellitus Display Reduced GLUT4 Expression and Soma Area in Hippocampal Neurons: Potential Involvement of Inflammation.

Diabetes mellitus (DM) is an important risk factor for dementia, which is a common neurodegenerative disorder. DM is known to activate inflammation, oxidative stress, and advanced glycation end products (AGEs) generation, all capable of inducing neuronal dysfunctions, thus participating in the neurodegeneration progress. In that process, disturbed neuronal glucose supply plays a key role, which in hippocampal neurons is controlled by the insulin-sensitive glucose transporter type 4 (GLUT4). We investigated the expression of GLUT4, nuclear factor NF-kappa B subunit p65 [NFKB (p65)], carboxymethyllysine and synapsin1 (immunohistochemistry), and soma area in human postmortem hippocampal samples from control, obese, and obese+DM subjects (41 subjects). Moreover, in human SH-SY5Y neurons, tumor necrosis factor (TNF) and glycated albumin (GA) effects were investigated in GLUT4, synapsin-1 (SYN1), tyrosine hydroxylase (TH), synaptophysin (SYP) proteins, and respective genes; NFKB binding activity in the SLC2A4 promoter; effects of increased histone acetylation grade by histone deacetylase 3 (HDAC3) inhibition. Hippocampal neurons (CA4 area) of obese+DM subjects displayed reduced GLUT4 expression and neuronal soma area, associated with increased expression of NFKB (p65). Challenges with TNF and GA decreased the SLC2A4/GLUT4 expression in SH-SY5Y neurons. TNF decreased SYN1, TH, and SYP mRNAs and respective proteins, and increased NFKB binding activity in the SLC2A4 promoter. Inhibition of HDAC3 increased the SLC2A4 expression and the total neuronal content of CRE-binding proteins (CREB/ICER), and also counterbalanced the repressor effect of TNF upon these parameters. This study revealed reduced postmortem human hippocampal GLUT4 content and neuronal soma area accompanied by increased proinflammatory activity in the brains of DM subjects. In isolated human neurons, inflammatory activation by TNF reduced not only the SLC2A4/GLUT4 expression but also the expression of some genes related to neuronal function (SYN1, TH, SYP). These effects may be related to epigenetic regulations (H3Kac and H4Kac status) since they can be counterbalanced by inhibiting HDAC3. These results uncover the improvement in GLUT4 expression and/or the inhibition of HDAC3 as promising therapeutic targets to fight DM-related neurodegeneration.

Transforming the invisible into the visible: disparities in the access to health in LGBT+ older people.

OBJECTIVES: To compare variables of access to healthcare between the LGBT+ population aged 50 and over and those non-LGBT+. METHODS: A cross-sectional study was carried out in Brazil through a confidential online questionnaire. The use of the health system was characterized by the number of preventive tests performed and measured by the PCATool-Brasil scale (a 10-point scale in which higher scores were associated with better assistance in healthcare). The association between being LGBT+ and access to health was analyzed in Poisson regression models. RESULTS: 6693 participants (1332 LGBT+ and 5361 non-LGBT+) with a median age of 60 years were included. In the univariate analysis, it was observed not only lower scores on the PCATool scale (5.13 against 5.82, p < 0.001), but a greater proportion of individuals among those classified with the worst quintile of access to healthcare (< 4 points), 31% against 18% (p < 0.001). Being LGBT+ was an independent factor associated with worse access to health (PR = 2.5, 95% CI 2.04‒3.06). The rate of screening cancer, for breast, colon, and cervical cancer was also found to be lower in the LGBT+ population. CONCLUSION: Healthcare access and health service experiences were worse in the LGBT+ group than in their non-LGBT peers. Inclusive and effective healthcare public policies are essential to promote healthy aging for all.

Transforming the invisible into the visible: disparities in the access to health in LGBT+ older people

Abstract Objectives: To compare variables of access to healthcare between the LGBT+ population aged 50 and over and those non-LGBT+. Methods: A cross-sectional study was carried out in Brazil through a confidential online questionnaire. The use of the health system was characterized by the number of preventive tests performed and measured by the PCATool-Brasil scale (a 10-point scale in which higher scores were associated with better assistance in healthcare). The association between being LGBT+ and access to health was analyzed in Poisson regression models. Results: 6693 participants (1332 LGBT+ and 5361 non-LGBT+) with a median age of 60 years were included. In the univariate analysis, it was observed not only lower scores on the PCATool scale (5.13 against 5.82, p < 0.001), but a greater proportion of individuals among those classified with the worst quintile of access to healthcare (< 4 points), 31% against 18% (p < 0.001). Being LGBT+ was an independent factor associated with worse access to health (PR = 2.5, 95% CI 2.04‒3.06). The rate of screening cancer, for breast, colon, and cervical cancer was also found to be lower in the LGBT+ population. Conclusion: Healthcare access and health service experiences were worse in the LGBT+ group than in their non-LGBT peers. Inclusive and effective healthcare public policies are essential to promote healthy aging for all.

Adaptation to the driving simulator and prediction of the braking time performance, with and without distraction, in older adults and middle-aged adults

Abstract Context: Many studies show the importance of evaluating the adaptation time of subjects in a virtual driving environment, looking forwards to a response as closest as a possible real vehicle. Objectives: This study aimed to identify and analyze the adaptation to the driving simulator in older adults and middle-aged adults with and without a distraction, and a secondary aim was to identify predictors of safe performance for older adults' drives. Design: Male and female middle-aged adults (n = 62, age = 30.3 ± 7.1 years) and older adults (n = 102, age = 70.4 ± 5.8 years) were evaluated for braking time performance in a driving simulator; cognition performance assessment included the Mini-Mental State Examination; motor evaluation included ankle flexor muscle strength with the isokinetic dynamometer and handgrip strength; the postural balance was evaluated with Timed Up and Go test, with and without a cognitive distraction task. Results: Older adults (men and women) and middle-aged adult women require more time to adapt to the driving simulator. The distractor increases the adaptation time for all groups. The main predictors of braking time for older women are age, muscle strength, and postural balance associated with distraction, and for older men, muscle strength. Conclusions: Age, sex, and distractor interfere in the adaptation of the virtual task of driving in a simulator. The evaluation model developed with multi-domains demonstrated the ability to predict which skills are related to braking time with and without the presence of the distractor.

Aspectos demográficos e acesso aos projetos pedagógicos dos cursos de Medicina no Brasil / Demographic aspects and access to the pedagogical projects of medical courses in Brazil

Resumo: Introdução: A ampliação da educação superior no Brasil é recente. Na área médica, com o advento do Programa Mais Médicos, essa expansão tornou-se viável e culminou com a publicação de novas Diretrizes Curriculares Nacionais (DCN) para o curso de graduação em Medicina. O projeto pedagógico do curso (PPC) traduz o que se realiza no curso e funciona como instrumento de comunicação entre a instituição e a sociedade. A análise dos PPC das instituições de ensino superior propicia a identificação de elementos que apontam para convergência ou se afastam do preconizado nas mudanças pretendidas pelas DCN de 2014. Objetivo: Este estudo descreve demograficamente no Brasil o número de cursos de Medicina públicos e privados por estado e região da Federação, o número de vagas disponíveis e o acesso aos PPC dessas escolas por meio de metodologia sistematizada. Método: Realizou-se um levantamento de todas as faculdades com curso de Medicina no Brasil, no ano de 2021. A procura dos PPC foi realizada no site institucional. Em caso de ausência da informação, encaminhamos mensagem eletrônica à coordenação do curso de Medicina. Na indisponibilidade de contato direto com a coordenação pelo site institucional, encaminhamos mensagem ao coordenador por meio do acesso ao seu Currículo Lattes. Resultado: Foram identificadas 336 escolas médicas, 115 (34,2%) públicas e 226 (65,8%) privadas. Observamos a maior concentração de cursos na Região Sudeste (41,3%), seguida da Região Nordeste (24,6%). Das instituições públicas, o Nordeste é a região que mais concentra as escolas (35,6%), seguida da Região Sudeste (26%). Quanto às instituições privadas, ocorre o inverso. Obteve-se um total de 134 PPC (39,8%), sendo 111 (83%) das escolas públicas e 23 (17%) das privadas. Conclusão: Embora a disponibilização do documento de informação pedagógica no site da instituição seja obrigatória, isso não foi verificado em realidade, o que corrobora a necessidade de políticas de valorização e fiscalização da disponibilidade do PPC para facilitar o seu acesso pelos maiores interessados: alunos, comunidade acadêmica e pesquisadores da área da educação médica.

Abstract Introduction: The expansion of higher education in Brazil is recent. In the medical field, with the advent of the "Mais Médicos" Program, this expansion became feasible and culminated with the publication of new National Curricular Guidelines (DCN, Diretrizes Curriculares Nacionais) for undergraduate medical courses. The Pedagogical Course Project (PCP) translates what is accomplished in the course and works as an instrument of communication between the institution and society. The analysis of the PCPs of Higher Education Institutions provides the identification of elements that point to the convergence or move away from the changes proposed by the DCN 2014. Objective: To describe demographically in Brazil the number of public and private medical courses by state and region of the federation, the number of available vacancies, and access to the PCPs of these schools through a systematized methodology. Method: A study was carried out in all institutions with medical courses in Brazil by the year 2021. The search for the PCPs was carried out in the institutional website. In case of lack of information, an electronic message was sent to the medical course coordination. When it was not possible to contact the coordinator directly through the institutional website, a message was sent to the coordinator by accessing their curriculum lattes. Results: A total of 336 medical schools were identified, 115 (34.2%) of which were public and 226 (65.8%) private ones. A higher concentration of courses was observed in the southeast region (41.3%), followed by the northeast region (24.6%). Of the public institutions, the northeast region has the highest concentration of schools (35.6%), followed by the southeast region (26%). The opposite was observed regarding the private institutions. A total of 134 PCPs were obtained (39.8% of the total), 83% from public schools and 17% from private ones. Conclusion: Although the availability of the pedagogical information document on the institution's website is an obligation, this was not verified in reality, which makes it necessary to implement policies for valuing and monitoring PCP availability, thus facilitating its access by the most interested parties: students, the academic community and researchers in the field of medical education.

Impact of oral health on frailty syndrome in frail older adults

ABSTRACT Objective This study aimed to correlate oral and general health in frail and non-frail older adults. Methods This observational study included 52 older adults, of whom 35 were frail (Frail Group), and 17 were non-frail (Non-Frail Group), according to Fried's self-reported test addressing oral health variables, number of systemic diseases, and medications in use. The geriatric oral health assessment index was used to assess the oral hygiene of the groups. Results The number of preserved teeth in dentulous older adults was significantly higher in the Non-Frail Group (p=0.048). No significant differences were observed between the two groups in the use of dental prostheses or in the detection of soft tissue lesions. Overall, 74.3% of the Frail Group had a "bad" geriatric oral health index score, which significantly differed from that of the Non-Frail Group (p=0.045). The numbers of systemic diseases and medicines used were higher in the Frail Group than in the Non-Frail Group (p<0.001), demonstrating the pathophysiological characteristics of multimorbidity and polypharmacy in frailty syndrome. Conclusion The results showed a clear correlation between oral and general health conditions and frailty syndrome.

COVID-19 containment management strategies in a nursing home

ABSTRACT Objective: To describe the first COVID-19 pandemic at Casa Ondina Lobo, a philanthropic nursing home in São Paulo city, and the containment measures against the pandemic that proved to be effective. Methods: Several preventive measures were taken before and during the pandemic, with emphasis on universal testing by reverse transcription polymerase chain reaction for COVID-19. All residents and employees were tested twice in a D9 period. Results: Among the 62 residents and 55 employees, in both testing, eight residents and nine employees tested positive for COVID-19. Of 22% of employees and 75% of residents evolved asymptomatic, emphasizing the importance of universal testing for the detection and isolation of these cases. A quarter of residents evolved without any symptoms, however, with COVID-19 signs, reinforcing the importance of monitoring vital signs. The second testing did not detect any new cases among residents, demonstrating the effectiveness of the containment measures, however, it found four new cases among employees. This emphasized their role in COVID-19 outbreaks in nursing homes. Only one patient died, a 12.5% lethality among those known to be infected and a 1.6% mortality in the total population of residents were seen. Conclusion: The adoption of appropriate containment measures enabled to contain an COVID-19 pandemic in studied nursing home. Universal reverse transcription polymerase chain reaction testing for COVID-19 has proved to be particularly important and effective.

Microcephaly measurement in adults and its association with clinical variables

ABSTRACT OBJECTIVE To establish a microcephaly cut-off size in adults using head circumference as an indirect measure of brain size, as well as to explore factors associated with microcephaly via data mining. METHODS In autopsy studies, head circumference was measured with an inelastic tape placed around the skull. Total brain volume was also directly measured. A linear regression was used to determine the association of head circumference with brain volume and clinical variables. Microcephaly was defined as head circumference that were two standard deviations below the mean of significant clinical variables. We further applied an association rule mining to find rules associating microcephaly with several sociodemographic and clinical variables. RESULTS In our sample of 2,508 adults, the mean head circumference was 55.3 ± 2.7cm. Head circumference was related to height, cerebral volume, and sex (p < 0.001 for all). Microcephaly was present in 4.7% of the sample (n = 119). Out of 34,355 association rules, we found significant relationships between microcephaly and a clinical dementia rating (CDR) > 0.5 with an informant questionnaire on cognitive decline in the elderly (IQCODE) ≥ 3.4 (confidence: 100% and lift: 5.6), between microcephaly and a CDR > 0.5 with age over 70 years (confidence: 42% and lift: 2.4), and microcephaly and males (confidence: 68.1% and lift: 1.3). CONCLUSION Head circumference was related to cerebral volume. Due to its low cost and easy use, head circumference can be used as a screening test for microcephaly, adjusting it for gender and height. Microcephaly was associated with dementia at old age.

Use of potentially inappropriate medications and adverse events in older outpatients with acute conditions

ABSTRACT Objective To examine associations between potentially inappropriate medication, use and the risk of falls, unplanned hospitalization and death in older patients receiving initial care in a geriatric day hospital due to acute conditions. Methods Cohort study with older adults referred to a geriatric day hospital from 2014 to 2017 due to acute conditions. Patients were submitted to comprehensive geriatric assessment. Use of medications was analyzed according to Beers Criteria 2019. Outcome assessment was based on monthly follow-up telephone calls made over the course of one year. Results In this sample, 40.6% of patients had been prescribed at least one potentially inappropriate medication, particularly proton pump inhibitors (66.5%). Over the course of follow-up, 44.7% of patients receiving potentially inappropriate medications sustained at least one fall (p=0.0043) and 70% visited the emergency department (p=0.0452). These outcomes were more common among patients using two or more of drugs. Use of potentially inappropriate medication was associated with a 64% increase in the odds of unplanned hospitalization and a two-fold increase in risk of death. Conclusion Associations between potentially inappropriate medication use and unfavorable outcomes such as falls and unplanned hospitalizations within one year of admission to a geriatric day hospital support the application of Beers Criteria and emphasize the importance of periodic prescription review, deprescription and rational use of these drugs whenever possible.

Palliative care over the rainbow: perspectives of middleage and older LGBT+ adults regarding their end-of-life / Cuidados paliativos além do arco-íris: perspectivas de pessoas idosas LGBT+ relacionadas com o final de suas vidas

Objective: Reports show that LGBT+ people may face several struggles during their endof-life (EOF) preparations, reporting higher rates, for example, of harassment and fear of feeling pain during these moments. We thus aimed to investigate variables related to EOF preparations among LGBT+ people and compare them with heterosexual cisgender individuals. Methods: This is a cross-sectional study in which Brazilians aged 50 or older were invited to answer an anonymous online survey between August 2019 and January 2020. The survey was widely distributed in neighbourhood associations, nongovernmental organizations, and social media. Those who identified as homosexual, bisexual, pansexual, non-heterosexual, transgender, travesti, or non-binary were grouped as LGBT+; cisgender and heterosexual participants were grouped as non-LGBT+. Results: The questionnaire was answered by 6693 participants with a median age of 60 years. Out of all respondents, 1332 were LGBT+ (19.90%) and 5361 were non-LGBT+ (80.10%). Compared to their non-LGBT+ peers, LGBT+ people reported higher rates of loneliness (25.30% vs 16.32%, p < 0.001), fear of dying alone (15.69% vs 9.79%, p < 0.001) or in pain (35.21% vs 25.74%, p < 0.001), and less social support (19.44% vs 13.48%, p < 0.001). Conclusions: Being LGBT+ was associated with challenges and inequalities regarding EOF preparations and discussions. Sexuality and diversity should be addressed in palliative training programs to address the needs of the LGBT+ population and to provide them with a dignified death

Objetivos: Estudos observacionais mostram que pessoas LGBT+ enfrentam diversas barreiras e desafios em suas preparações de fim de vida, como, por exemplo, taxas maiores de discriminação e medo de sentir dor nesses momentos. Dessa forma, nosso objetivo foi investigar variáveis relacionadas às preparações de fim de vida entre pessoas LGBT+ e compará-las com as de indivíduos não LGBT+. Metodologia: Este foi um estudo de corte transversal, no qual brasileiros com 50 anos ou mais foram convidados a responder a um questionário online anônimo entre agosto de 2019 e janeiro de 2020. O link para respostas foi distribuído amplamente em associações, organizações não governamentais e mídias sociais. Aqueles que se identificassem como homossexuais, bissexuais, pansexuais, não heterossexuais, transgênero, travestis ou com gênero não binário foram agrupados no grupo LGBT+; pessoas cisgênero e heterossexuais constituíram o grupo não LGBT+. Resultados: O questionário foi respondido por 6693 participantes, com mediana de idade de 60 anos. Entre eles, 1332 eram LGBT+ (19,90%) e 5361 não LGBT+ (80,10%). Comparadas com seus contemporâneos não LGBT+, as pessoas LGBT+ referiram maiores taxas de solidão (25,30% vs. 16,32%, p < 0,001), medo de morrer sozinhas (15,69% vs. 9,79%, p < 0,001) ou com dor (35,21% vs. 25,74%, p < 0,001) e menor suporte social (19,44% vs. 13,48%, p < 0,001). Conclusões: Ser LGBT+ esteve associado com iniquidades e desafios relacionados às preparações e discussões de fim de vida. Sexualidade e diversidade devem ser abordadas em programas de formação em cuidados paliativos para se acessarem as necessidades e particularidades da população LGBT+ e, dessa forma, ser proporcionada uma morte com dignidade a todos.

Muscle strength and muscle mass as predictors of hospital length of stay in patients with moderate to severe COVID-19: a prospective observational study.

BACKGROUND: Strength and muscle mass are predictors of relevant clinical outcomes in critically ill patients, but in hospitalized patients with COVID-19, it remains to be determined. In this prospective observational study, we investigated whether muscle strength or muscle mass are predictive of hospital length of stay (LOS) in patients with moderate to severe COVID-19 patients. METHODS: We evaluated prospectively 196 patients at hospital admission for muscle mass and strength. Ten patients did not test positive for SARS-CoV-2 during hospitalization and were excluded from the analyses. RESULTS: The sample comprised patients of both sexes (50% male) with a mean age (SD) of 59 (±15) years, body mass index of 29.5 (±6.9) kg/m2 . The prevalence of current smoking patients was 24.7%, and more prevalent coexisting conditions were hypertension (67.7%), obesity (40.9%), and type 2 diabetes (36.0%). Mean (SD) LOS was 8.6 days (7.7); 17.0% of the patients required intensive care; 3.8% used invasive mechanical ventilation; and 6.6% died during the hospitalization period. The crude hazard ratio (HR) for LOS was greatest for handgrip strength comparing the strongest versus other patients (1.47 [95% CI: 1.07-2.03; P = 0.019]). Evidence of an association between increased handgrip strength and shorter hospital stay was also identified when handgrip strength was standardized according to the sex-specific mean and standard deviation (1.23 [95% CI: 1.06-1.43; P = 0.007]). Mean LOS was shorter for the strongest patients (7.5 ± 6.1 days) versus others (9.2 ± 8.4 days). Evidence of associations were also present for vastus lateralis cross-sectional area. The crude HR identified shorter hospital stay for patients with greater sex-specific standardized values (1.20 [95% CI: 1.03-1.39; P = 0.016]). Evidence was also obtained associating longer hospital stays for patients with the lowest values for vastus lateralis cross-sectional area (0.63 [95% CI: 0.46-0.88; P = 0.006). Mean LOS for the patients with the lowest muscle cross-sectional area was longer (10.8 ± 8.8 days) versus others (7.7 ± 7.2 days). The magnitude of associations for handgrip strength and vastus lateralis cross-sectional area remained consistent and statistically significant after adjusting for other covariates. CONCLUSIONS: Muscle strength and mass assessed upon hospital admission are predictors of LOS in patients with moderate to severe COVID-19, which stresses the value of muscle health in prognosis of this disease.

Severe Dementia Predicts Weight Loss by the Time of Death.

Background: Body mass index (BMI) in midlife is associated with dementia. However, the association between BMI and late-life obesity is controversial. Few studies have investigated the association between BMI and cognitive performance near the time of death using data from autopsy examination. We aimed to investigate the association between BMI and dementia in deceased individuals who underwent a full-body autopsy examination. Methods: Weight and height were measured before the autopsy exam. Cognitive function before death was investigated using the Clinical Dementia Rating (CDR) scale. The cross-sectional association between BMI and dementia was investigated using linear regression models adjusted for sociodemographic and clinical variables. Results: We included 1,090 individuals (mean age 69.5 ± 13.5 years old, 46% women). Most participants (56%) had a normal BMI (18.5-24.9 kg/m2), and the prevalence of dementia was 16%. Twenty-four percent of the sample had cancer, including 76 cases diagnosed only by the autopsy examination. Moderate and severe dementia were associated with lower BMI compared with participants with normal cognition in fully adjusted models (moderate: ß = -1.92, 95% CI = -3.77 to -0.06, p = 0.042; severe: ß = -2.91, 95% CI = -3.97 to -1.86, p < 0.001). Conclusion: BMI was associated with moderate and severe dementia in late life, but we did not find associations of BMI with less advanced dementia stages.

Alcohol Use Disorder is Associated with Upregulation of MicroRNA-34a and MicroRNA-34c in Hippocampal Postmortem Tissue.

BACKGROUND: To investigate epigenetic mechanisms potentially involved in the cognitive decline associated with chronic alcohol intake, we evaluated the expressions of three micro-RNAs (miR-34a, -34b, and -34c) highly expressed in the hippocampus and involved in neuronal physiology and pathology. MiR-34a participates in functioning and survival of mature neurons; miR-34b is associated with Alzheimer-like disorders; and miR-34c is implicated in the memory impairment of Alzheimer disease in rodents and humans. METHODS: A total of 69 cases were selected from the Biobank for Aging Studies and categorized according to the absence (n = 50) or presence (n = 19) of alcohol use disorder (AUD). Cases presenting with neuropathological diagnoses of dementias were excluded. Total RNA was extracted from hippocampal paraffinized slices, complementary DNA was synthesized from miRs, and RT-qPCR was performed with TaqMan® assays. RESULTS: Higher expressions of miR-34a and miR-34c, but not of miR-34b, were found in the group with AUD in comparison with the group without AUD after adjustment for potential confounders (age, sex, body mass index, presence of hypertension, diabetes mellitus, smoking, and physical inactivity). CONCLUSIONS: Hippocampal upregulation of miR-34a and miR-34c may be involved in the cognitive decline associated with chronic alcohol consumption.

Evaluation of the Diaphragm Muscle Remodeling, Inflammation, Oxidative Stress and Vascularization in Smokers: An Autopsy Study.

BACKGROUND/AIMS: Cigarette smoking is a key factor in systemic inflammation and oxidative stress, and it has also been associated with the loss of muscle strength and an elevated risk of pulmonary diseases. Thus, this study aimed to analyze the effects of cigarette smoking on the diaphragm muscle structure of postmortem samples. METHODS: Immunohistochemical techniques were used for muscle remodeling (metalloproteinases 2 and 9), inflammation (cyclooxygenase-2), oxidative stress (8-hydroxy-2'-deoxyguanosine), and vascularization (vascular endothelial growth factor). Hematoxylin and eosin stain was used for histopathological analysis and Picrosirius stain was used to highlight the collagen fibers. RESULTS: Cigarette smokers had an increase of diaphragm muscle remodeling, oxidative stress, inflammation, and vascularization compared to non-smokers. CONCLUSION: Diaphragm muscle structure may be negatively affected by cigarette smoking.