ABSTRACT
BACKGROUND: Growing evidence suggests that cerebral white-matter changes and depressive symptoms are linked directly along the causal pathway. We investigated whether baseline severity of cerebral white-matter changes predict longer-term future depressive outcomes in a community sample of non-disabled older adults. METHOD: In the Leukoaraiosis and Disability in the Elderly (LADIS) study, a longitudinal multi-centre pan-European study, 639 older subjects underwent baseline structural magnetic resonance imaging (MRI) and clinical assessments. Baseline severity of white-matter changes was quantified volumetrically. Depressive outcomes were assessed in terms of depressive episodes and depressive symptoms, as measured by the Geriatric Depression Scale (GDS). Subjects were clinically reassessed annually for up to 3 years. Regression models were constructed to determine whether baseline severity of white-matter changes predicted future depressive outcomes, after controlling for confounding factors. RESULTS: Baseline severity of white-matter changes independently predicted depressive symptoms at both 2 (p<0.001) and 3 years (p=0.015). Similarly, white-matter changes predicted incident depression (p=0.02). Over the study period the population became significantly more disabled (p<0.001). When regression models were adjusted to account for the influence of the prospective variable transition to disability, baseline severity of white-matter changes no longer predicted depressive symptoms at 3 years (p=0.09) or incident depression (p=0.08). CONCLUSIONS: Our results support the vascular depression hypothesis and strongly implicate white-matter changes in the pathogenesis of late-life depression. Furthermore, the findings indicate that, over time, part of the relationship between white-matter changes and depression may be mediated by loss of functional activity.
Subject(s)
Brain/pathology , Depressive Disorder, Major/diagnosis , Depressive Disorder, Major/pathology , Age of Onset , Aged , Aged, 80 and over , Depressive Disorder, Major/epidemiology , Disability Evaluation , Female , Humans , Magnetic Resonance Imaging , Male , Severity of Illness Index , Surveys and QuestionnairesABSTRACT
Twenty-one metabolites were detected in faecal samples collected after infusion of (14C)cortisol into the jugular vein of sheep. Using high-performance liquid chromatography/radiometric analysis plus mass spectrometry. One group of metabolites had molecular weights of between 302 and 308, and another group of 350, which indicates that the substances have a C19O3 or a C21O4 structure. Therefore, an enzyme immunoassay against 5beta-androstane-3alpha-ol-11,17-dione-17-CMO:BSA was established. Faecal samples were collected from 10 cows immediately after transport and then during a course in which non-invasive diagnostic procedures were being taught (course 1). For comparison, faeces were sampled from another 5 cows that were being used for teaching invasive procedures (course 2). Six cows from a university farm served as controls. In the animals used in course 1, the highest concentrations of cortisol metabolites were measured immediately after transport to the university (median value: 2.2 micromol/kg faeces). During the first 5 days at the university, the concentrations decreased to 0.52 micromol/kg (median) and remained at this level during the rest of the course. The median concentration in the samples that were taken during coursc 2 (collected about 2 months after transport) was 0.48 micromol/kg. There was no significant difference in the excretion of cortisol metabolites between these cows and the controls. We conclude from these data that, using the enzyme immunoassay against 5beta-androstane-3alpha-ol-11,17-dione-17-CMO, we were able to detect transport/novel environment stress but not the potential disturbance that cows experience during diagnostic procedures.
Subject(s)
Carbon Radioisotopes/metabolism , Cattle/metabolism , Feces/chemistry , Hydrocortisone/analysis , Hydrocortisone/metabolism , Sheep/metabolism , Animals , Chromatography, Liquid , Female , Immunoenzyme Techniques , Logistic Models , Male , Mass Spectrometry , Stress, Physiological/diagnosis , Stress, Physiological/metabolism , Time FactorsABSTRACT
The surgeon has to keep abreast of changing advantages and disadvantages as well as alternatives in the context of homologous blood transfusions. We ought to realise that normovolaemic anaemia is better tolerated than we used to assume in the past. It is no longer necessary to provide transfusions to patients with 10 g/% Hb. About 8 g/% should rather be considered the adequate threshold. Possible transmission of hepatitis and AIDS virus is a genuine risk associated with blood transfusion. No hard evidence has yet been produced to immunosuppression and effects on the prognosis of cancer patients. More attention will have to be given in the future to preoperative supply of blood for autohaemotherapy.