Financial Hardship and Health Related Quality of Life Among Older Latinos With Chronic Diseases.

BACKGROUND: Financial hardship influences health-related quality of life (HRQoL) of older adults. However, little is known about the relationship between financial hardship and HRQoL among vulnerable populations. OBJECTIVE: We examined the associations between financial hardship and HRQoL among older Latinos living with chronic disease, including cancer. METHODS: This cross-sectional study included 68 Latinos (age range 50-87) with one or more chronic health conditions who participated in a pilot randomized clinical trial. Participants responded to 11 financial hardship questions. We used factor analysis to explore constructs of financial hardship. HRQoL was assessed using the 27-item Functional Assessment of Cancer Therapy-General (FACT-G). Multiple linear regression examined the associations between financial hardship and HRQoL subscales (physical, social/family, emotional, functional well-being). RESULTS: The factor analysis revealed 3 constructs of financial hardship: medical cost concerns, financial hardship treatment adherence, and financial worry. A 1-point increase in the factor score for financial hardship treatment adherence was associated with a 2.1-point (SE = 0.771) decrease in physical well-being and with a 1.71-point (SE = 0.761) decrease in functional well-being. A 1-point increase in the financial stress factor score was associated with a 2.0-point (SE = 0.833) decrease in social/family well-being, and with a 2.1-point (SE = 0.822) decrease in functional well-being. CONCLUSION: In this study of older Latinos with chronic diseases, financial hardship was associated with worse HRQoL across several domains. Healthcare providers should refer older Latinos living with chronic disease to appropriate support providers, such as care coordinators, social workers, or patient navigators, who can assist them with obtaining financial assistance and other resources.

Endovascular treatment in the acute and non-acute phases of carotid dissection: a therapeutic approach.

BACKGROUND: Carotid dissection (CD) may, in certain cases, lead to significant stenosis, occlusion, or pseudoaneurysm formation, causing embolic stroke or hemodynamic failure, despite medical therapy. OBJECTIVE: To evaluate the results of endovascular treatment and clinical outcomes of patients with CD. METHODS: A four-hospital retrospective study of endovascular treatment of extracranial CD in which medical treatment had failed or patients presented with a National Institute of Health Stroke Scale (NIHSS) score ≥8. RESULTS: Thirty-eight patients (mean age 46.6±13.5 years, 78.9% male, 84.2% spontaneous CD, 44.7% left CD and 26.3% bilateral CD) were analyzed. In 24 patients (63.2%) treatment was undertaken in the acute-phase CD (APCD). IV recombinant tissue plasminogen activator was administered in 7 (29.2%) APCD cases. The patients with APCD exhibited a high rate of successful revascularization (Thrombolysis In Cerebral Infarction ≥2b; 19 patients (79.2%)), a low risk of symptomatic intracranial hemorrhage (n=2 (8.3%)), and good global functional outcomes (modified Rankin Scale (mRS) ≤2; n=17 (70.8%)). Good recanalization correlated (p=0.001) with good clinical evolution (mRS ≤2) in the patients with APCD. Of the 14 patients with non-acute phase CD (NAPCD), seven were treated for pseudoaneurysm with multiple stents (six patients) or covered prostheses, with stenosis being treated in the remaining seven patients. CONCLUSIONS: Endovascular treatment of selected cases of patients with CD associated with thromboembolic events and hemodynamic failure after unsuccessful medical therapy is a safe and effective method of restoring vessel lumen integrity, with good short-term clinical evolution.

Bilingualism in older Mexican-American immigrants is associated with higher scores on cognitive screening.

BACKGROUND: Bilingualism may protect against cognitive aging and delay the onset of dementia. However, studies comparing monolinguals and bilinguals on such metrics have produced inconsistent results complicated by confounding variables and methodological concerns. METHODS: We addressed this issue by comparing cognitive performance in a more culturally homogeneous cohort of older Spanish-speaking monolingual (n = 289) and Spanish-English bilingual (n = 339) Mexican-American immigrants from the Sacramento Longitudinal Study on Aging. RESULTS: After adjusting for demographic differences and depressive symptoms, both groups performed similarly at baseline on verbal memory but the bilingual group performed significantly better than the monolingual group on a cognitive screening test, the Modified Mini-Mental State Examination (3MS; p < 0.001). Group differences on the 3MS were driven by language/executive and language/praxis factors. Within the bilingual group, neither language of testing nor degree of bilingualism was significantly associated with 3MS or verbal memory scores. Amongst individuals who performed in the normal or better range on both tests at baseline and were followed for an average of 6 years, both monolinguals and bilinguals exhibited similar rates of cognitive decline on both measures. CONCLUSIONS: These findings suggest that bilingualism is associated with modest benefits in cognitive screening performance in older individuals in cross-sectional analyses that persist across longitudinal analyses. The effects of bilingualism should be considered when cognitively screening is performed in aging immigrant populations.

Percutaneous radiofrequency ablation of renal tumors in solitary kidney patients.

OBJECTIVES: In solitary kidney patients with renal cell carcinoma (RCC), radiofrequency ablation (RFA) could be effective in achieving complete tumor necrosis without increasing the risk of complications or renal failure. To analyze the outcomes of a group of solitary kidney patients treated for RCC by RFA considering tumor size and location, renal function involvement and complications. METHODS: A transversal retrospective study was performed, in which we selected 11 solitary kidney patients with 19 tumors in total treated by RFA for one or more renal tumors. A CT protocol was used for follow up. It included unenhanced series and contrast enhanced series at 1 month, 3-6 months, 12 months and yearly after RFA. Serum creatinine levels of each patient, pre RFA and within the first 48 hours after RFA, were collected. RESULTS: Complete ablation was achieved in 17 tumors (89.4%) after one or two RFA sessions. 100% of exophytic and parenchymal tumors, and 3 cm size or smaller, were completely ablated. Renal failure, immediate complications or more than 24 hours hospitalization were not observed in 10 (90.1%) of our patients. CONCLUSIONS: RFA treatment for RCC in solitary kidney patients has a high success rate; it does not affect renal function and achieves complete initial tumor necrosis, especially in exophytic, parenchymal and 3 cm or smaller lesions.

In vitro suppression of xenoimmune-mediated macrophage activation by human CD4+CD25+ regulatory T cells.

BACKGROUND: Macrophages are important effector cells in T cell-mediated xenograft rejection. The aim of this study was to determine whether CD4+CD25+ regulatory T cells (Tregs) were capable of suppressing macrophage activation in vitro. METHODS: Porcine cell or xenoantigen-primed human peripheral blood mononuclear cells, CD4+ T cell-depleted peripheral blood mononuclear cells, or CD14+ macrophages plus autologous CD4+CD25- T cells were cultured with or without expanded autologous Tregs. Transwell cultures were used to separate the various components to determine the need for cell-cell contact. RESULTS: Pig cell primed CD14+ macrophages required the presence of CD4+CD25- T cells for activation and increased expression of CD40, interleukin-12, and tumor necrosis factor-alpha. This up-regulated expression of macrophage activation markers was reduced substantially in the presence of autologous Tregs. Coculture with Tregs did not alter macrophage viability but reduced the capacity of macrophages to stimulate proliferation of responder T cells. Tregs required direct contact with CD4+CD25- T cells to inhibit macrophage activation but activated macrophage phenotype was not altered by separating the stimulated human peripheral blood mononuclear cells or CD14+ macrophages from Tregs in a transwell system. Macrophages did not require direct cell contact with porcine stimulator cells for full activation by CD4+CD25- T cells. CONCLUSIONS: Human Tregs were able to suppress xenoantigen-primed and CD4+ T-cell-mediated macrophage activation and antigen-presenting cell function. However, Tregs had no direct effect on macrophages in vitro.

Efectos vasculares del tiopental / Vascular efects of thiopental

Se evaluaron los efectos del tiopental en anillos de aorta de rata. El anestésico produjo contracción que aumentó al quitar el endotelio y no se inhibió con indometacina (10-5M). Prazosina (10-6M) o idazoxan (10-6M) o diltiazem (10-6M) pero disminuyó en un medio sin calcio. Por otra parte, el tiopental relajó anillos aórticos precontraídos con fenilefrina (10-6M), angiotensina II (10-7), serotonina (3.1 x 10-5 M) o KCI (40 mM), en forma independiente del endotelio. Finalmente, la exposición al tiobarbitúrico (3.1 mg/ml) inhibió reversiblemente la relajación ocasionada por histamina, pero no por el nitroprusiato de sodio o por el A23187. Los resultados permiten concluir que, en la aorta de rata, el tiopental produce: a) contracción modulada inhibitoriamente por el endotelio y dependiente del calcio extracelular que ingresa a través de canales insensibles a diltiazem, y que no es mediada por prostaglandinas o receptores adrenérgicos; b) relajación independiente tanto del endotelio como del agente contráctil empleado; c) inhibición de la relajación dependiente de endotelio ocasionada por histamina. Efecto que no parece deberse a alteración de la guanilato ciclasa o de la sintasa de óxido nítrico, puesto que el anestésico no inhibió el efecto del nitropusiato de sodio o del A23187. Por lo anteriormente expuesto, consideramos posible que los diversos efectos vasculares del tiopental se asocien con su capacidad para disolverse en las membranas del músculo liso y del endotelio de la aorta, alterando componentes funcionales de las mismas