Mini Nutritional Assessment May Identify a Dual Pattern of Perturbed Plasma Amino Acids in Patients with Alzheimer's Disease: A Window to Metabolic and Physical Rehabilitation?

Conflicting results about alterations of plasma amino acid (AA) levels are reported in subjects with Alzheimer's disease (AD). The current study aimed to provide more homogeneous AA profiles and correlations between AAs and cognitive tests. Venous plasma AAs were measured in 54 fasting patients with AD (37 males, 17 females; 74.63 ± 8.03 yrs; 3.2 ± 1.9 yrs from symptom onset). Seventeen matched subjects without neurodegenerative symptoms (NNDS) served as a control group (C-NNDS). Patients were tested for short-term verbal memory and attention capacity and stratified for nutritional state (Mini Nutritional Assessment, MNA). Compared to C-NNDS, patients exhibited lower plasma levels of aspartic acid and taurine (p < 0.0001) and higher 3-methylhistidine (p < 0.0001), which were independent of patients' MNA. In comparison to normonourished AD, the patients at risk of and with malnutrition showed a tendency towards lower ratios of Essential AAs/Total AAs, Branched-chain AAs/Total AAs, and Branched-chain AAs/Essential AAs. Serine and histidine were positively correlated with verbal memory and attention capacity deficits, respectively. Total AAs negatively correlated with attention capacity deficits. Stratifying patients with AD for MNA may identify a dual pattern of altered AAs, one due to AD per se and the other linked to nutritional state. Significant correlations were observed between several AAs and cognitive tests.

Ambulatory 24-h ECG monitoring and cardiovascular autonomic assessment for the screening of silent myocardial ischemia in elderly type 2 diabetic hypertensive patients.

The aim of the study was to evaluate the usefulness of Holter monitoring for the detection of silent myocardial ischemia (SMI) in elderly type 2 diabetic patients with hypertension and the possible relationship between SMI and cardiovascular autonomic neuropathy (CAN). Two hundred and forty-three asymptomatic outpatients, aged 65-75 years, with type 2 diabetes and essential hypertension underwent 24-h ECG monitoring and 5 tests for the evaluation of both parasympathetic (heart rate variability, response to breath deeping, and Valsalva manoeuvre) and sympathetic (cold pressor test and orthostatic hypotension test) autonomic function. A total of 518 asymptomatic episodes of ST depression during Holter monitoring indicative of SMI were detected in 51 of the 243 studied patients (20.9 %). None of the patients with ST depression episodes exhibited a normal response to at least one of the evaluated autonomic function tests, whereas 22 of the 192 patients without ST changes (11.4 %) exhibited a normal response to all tests. Abnormality in both parasympathetic and sympathetic function test responses was found in 94.1 % of patients with ST depression episodes vs 26.1 % of those without ST changes (P < 0.001). Statistical evaluation of the relationship between the abnormal response to single autonomic function test and episodes of ST depression was highly significant for all the 5 tests (P < 0.001). These results indicate that: (a) Holter monitoring enables to detect ST segment changes indicative of SMI in 20.9 % of elderly diabetic patients with hypertension; (b) the presence of autonomic cardiac dysfunction in these patients suggests a role of diabetic neuropathy in the pathogenesis of SMI; and

Urban hierarchy in the brazilian Amazon / A hierarquia urbana na Amazônia / La jerarquía urbana en la Amazonia

The Grade of Membership (GoM) model is used to outline profiles based on a heterogeneous and multidimensional database, which allows identifying clusters and describing the differences among them. In this study, GoM uses several types of variables so as to improve the understanding of the greatness and power of Amazonian cities. To accomplish this task, a model that takes into account a variety of aspects, which exceed a purely economic or demographic analysis, is proposed. Understanding the hierarchical organization of the cities in the Amazon seems to be a very important exercise in order to understand the dynamics and specific characteristics of regional urban nets. In this way, it is evident that policies which stimulate the establishment of more structured urban nets in the Amazon are needed. A more balanced population distribution throughout the territory could bring a series of benefits, especially when it comes to the offer and access to all different sorts of services.

O modelo Grade of Membership (GoM) é utilizado para delinear perfis, com base em um banco de dados heterogêneo e multidimensional, o que permite identificar grupos (clusters) e descrever as diferenças entre os mesmos. Neste trabalho, o GoM utiliza diversos tipos de variáveis, que objetivam uma maior compreensão da grandeza e da capacidade de influência das cidades amazônicas. Para cumprir tal tarefa, propõe-se um modelo que considera uma diversidade de aspectos que extrapolam as análises de ordem puramente econômica ou demográfica. Entender a organização hierárquica das cidades na Amazônia parece ser um exercício de grande importância para a compreensão do dinamismo e das especificidades das redes urbanas na região. Nesse sentido, parece evidente a necessidade de políticas que incentivem o estabelecimento de redes urbanas mais estruturadas na Amazônia. Uma distribuição mais equilibrada da população ao longo do território amazônico poderia trazer uma série de ganhos, sobretudo no que se refere à oferta e ao acesso a serviços de diversos tipos e níveis de sofisticação.

El modelo Grade of Membership (GoM) se utiliza para trazar perfiles, en base a un banco de datos heterogéneo y multidimensional, lo que permite identificar grupos (clusters) y describir las diferencias entre los mismos. En este trabajo, el GoM utiliza diversos tipos de variables, que tienen como objetivo una mayor comprensión de la grandeza y de la capacidad de influencia de las ciudades amazónicas. Para cumplir tal tarea, se propone un modelo que considera una diversidad de aspectos que extrapolan los análisis de orden puramente económico o demográfico. Entender la organización jerárquica de las ciudades en la Amazonia parece ser un ejercicio de gran importancia para la comprensión del dinamismo y de las especificidades de las redes urbanas en la región. En este sentido, parece evidente la necesidad de políticas que incentiven el establecimiento de redes urbanas más estructuradas en la Amazonia. Una distribución más equilibrada de la población a lo largo del territorio amazónico podría proporcionar una serie de beneficios, sobre todo en lo que se refiere a la oferta y acceso a servicios de diversos tipos y niveles de sofisticación.