Validity of Normative Volumetric Estimates from Open Access Software in Amnestic Mild Cognitive Impairment.

BACKGROUND: Neurodegeneration in Alzheimer's disease (AD) is typically assessed through brain MRI. Although proprietary software can provide normative estimates of regional atrophy, such tools can be cost-prohibitive for research settings. Free software for generating normative estimates has recently been released but has yet to be validated in the context of amnestic mild cognitive impairment (aMCI). OBJECTIVES: Determine whether normative morphometric estimates generated from open-source software replicate established patterns of neurodegeneration in aMCI, and whether these metrics correlate with episodic memory performance. DESIGN: Observational study of brain MRI and cognition in aging and aMCI with two identical study visits occurring approximately 1.2 years apart. SETTING: Participants were recruited from the local community and outpatient clinical settings. PARTICIPANTS: Adults ages 60-85 with aMCI (n = 25) and cognitively normal controls (CN; n = 74). A subset returned for follow-up (aMCI n = 11, CN n = 52). MEASUREMENTS: Participants completed brain MRI and two neuropsychological tests of verbal episodic memory. FreeSurfer v6.0 and Normative Morphometry Image Statistics were used to generate normative morphometric estimates for AD-relevant regions (hippocampus, parahippocampus, entorhinal cortex, amygdala) and control regions (cuneus, lingual gyrus, pericalcarine gyrus), adjusting for age, sex, head size, scanner manufacturer, and field strength. We tested for baseline group differences in ROI volumes and memory and assessed their within-group associations. We also evaluated changes in ROI volumes over time and tested whether these changes corresponded to declines in memory. RESULTS: At baseline, the aMCI group exhibited poorer memory and smaller volumes in AD-relevant regions than the CN group. There were no group differences in control region volumes. Memory was associated with volumes in AD-relevant regions in the aMCI group only. The aMCI group exhibited greater declines than the CN group in hippocampal volume (17% vs. 8% annual decline) and entorhinal volume (54% vs. 5% annual decline). Decrease in hippocampal volume was marginally associated with decline in memory for the aMCI group. CONCLUSIONS: Normative morphometric values generated from freely available software demonstrated expected patterns of group differences in AD-related volumes and associations with memory. Significant effects were localized to AD-relevant brain regions and only occurred in the aMCI group. These findings support the validity of these free tools as reliable and cost-effective alternatives to proprietary software for use in research settings.

Neuromuscular blockade with rocuronium bromide increases the tolerance of acute normovolemic anemia in anesthetized pigs.

BACKGROUND: The patient's individual anemia tolerance is pivotal when blood transfusions become necessary, but are not feasible for some reason. To date, the effects of neuromuscular blockade (NMB) on anemia tolerance have not been investigated. METHODS: 14 anesthetized and mechanically ventilated pigs were randomly assigned to the Roc group (3.78 mg/kg rocuronium bromide followed by continuous infusion of 1 mg/kg/min, n = 7) or to the Sal group (administration of the corresponding volume of normal saline, n = 7). Subsequently, acute normovolemic anemia was induced by simultaneous exchange of whole blood for a 6% hydroxyethyl starch solution (130/0.4) until a sudden decrease of total body O(2) consumption (VO(2)) indicated a critical limitation of O(2) transport capacity. The Hb concentration quantified at this time point (Hb(crit)) was the primary endpoint of the protocol. Secondary endpoints were parameters of hemodynamics, O(2) transport and tissue oxygenation. RESULTS: Hb(crit) was significantly lower in the Roc group (2.4 ± 0.5 vs. 3.2 ± 0.7 g/dl) reflecting increased anemia tolerance. NMB with rocuronium bromide reduced skeletal muscular VO(2) and total body O(2) extraction rate. As the cardiac index increased simultaneously, total body VO(2) only decreased marginally in the Roc group (change of VO(2) relative to baseline -1.7 ± 0.8 vs. 3.2 ± 1.9% in the Sal group, p < 0.05). CONCLUSION: Deep NMB with rocuronium bromide increases the tolerance of acute normovolemic anemia. The underlying mechanism most likely involves a reduction of skeletal muscular VO(2). During acellular treatment of an acute blood loss, NMB might play an adjuvant role in situations where profound stages of normovolemic anemia have to be tolerated (e.g. bridging an unexpected blood loss until blood products become available for transfusion).

Smoking among males in the UK Armed Forces: changes over a seven year period.

OBJECTIVES: We assessed socio-demographic and military factors associated with smoking among males in the UK Armed Forces; made comparisons with the general population; and, tested the hypothesis that smoking has declined in the Armed Forces. METHODS: Using data from two cross-sectional studies (conducted in 1998 and 2004), we examined the patterns of smoking among regular male UK Service personnel aged 20-49 years and made comparisons with general population data from England, Scotland and Wales. RESULTS: In 2004, the prevalence of smoking among military males aged 20-49 years was 30% (n=2276), compared to 33% within the general population. Among current smokers, the mean number of cigarettes smoked per day was 15 for the military and 14 for the general population. The prevalence of smoking has decreased in lower ranks between 1998 and 2004 by 5.1% in 20-24 year olds to 6.3% in 35-49 year olds. These decreases are similar to those seen within those in the routine, manual or intermediate socio-economic group. CONCLUSIONS: Smoking among males in the UK military is associated with similar factors to those in the general population. As these factors are clustered in younger personnel, policies to decrease smoking should be targeted at younger recruits.

Potential health risks of complementary alternative medicines in HIV patients.

OBJECTIVES: To determine the prevalence and purpose of complementary alternative medicines (CAMs) use in people receiving treatment for HIV infection. To identify and quantify potential health risks of CAM use in this population and to explore options for improved pharmacovigilance. METHODS: Cross-sectional questionnaire survey of 293 patients receiving antiretroviral (ARV) therapy at three specialist HIV out-patient clinics in central London, UK. The use of herbal medicines and supplements was explored, and potentially adverse side effects or significant drug interactions with conventional therapies were identified. RESULTS: Of the 293 patients included, 61% (n=179) were taking herbal remedies or supplements and 35% (n=103) were using physical treatments. Twenty-seven per cent (n=80) used a combination of both. Twenty per cent (n=59) potentially compromised their HIV management through using CAM therapy. Ten per cent (n=29) were advised to stop their CAMs and 15% (n=43) were made aware of potential drug interactions and adverse effects and were advised to monitor their care. CONCLUSIONS: There are potentially significant health risks posed by the concomitant use of CAMs in patients taking ARV therapy. Medical practitioners need to be able to identify CAM use in HIV-positive patients and recognize potential health risks. Patients should be encouraged to disclose CAM use to their clinicians and other healthcare professionals.

How do experiences in Iraq affect alcohol use among male UK armed forces personnel?

OBJECTIVES: This paper reports on a statistically significant association between alcohol use and deployment to the 2003 Iraq War. It assesses the occupational factors and deployment experiences associated with heavy drinking in regular UK servicemen deployed to Iraq in the first phase of the 2003 Iraq War (Operation TELIC 1, the military codename for the conflict in Iraq). METHODS: A random representative sample of 3578 regular male UK Armed Forces personnel who were deployed to Iraq during Operation TELIC 1 participated in a cross-sectional postal questionnaire study (response rate 61%). Participants completed a questionnaire, between June 2004 and March 2006 (ie, after deployment), about their health, including a measure of alcohol use (Alcohol Use Disorders Identification Test, AUDIT) and questions about their experiences on deployment to Iraq. Heavy drinkers were identified as those scoring 16 or above on the AUDIT. RESULTS: After adjustment for sociodemographic and military factors, and the presence of psychological distress, heavy drinkers were more likely to have had major problems at home during (odds ratio (OR) 1.33, 95% confidence interval (CI) 1.04 to 1.70) and following their deployment (OR 1.68, 95% CI 1.32 to 2.14). Being deployed with their parent unit (OR 1.28, 95% CI 1.02 to 1.61), medium to high in-theatre unit comradeship (medium: OR 1.35, 95% CI 1.04 to 1.77; high: OR 1.35, 95% CI 1.02 to 1.79) and poor unit leadership (OR 1.78, 95% CI 1.37 to 2.31) were also associated with heavy drinking. CONCLUSIONS: Deployment experiences and problems at home during and following deployment, as well as the occupational milieu of the unit, influence personnel's risk of heavy drinking.

Correlates and predictors of adiposity among Mohawk children.

BACKGROUND: High rates of Type 2 diabetes in Native populations underlie the need for research on risk factors, including physical activity (PA) and obesity. METHODS: In 1994 and in 1996, 103 girls and 95 boys [mean age (standard deviation): 7.5 (1.3) years] attending elementary schools in two Mohawk communities completed a questionnaire assessing demographic and lifestyle variables. In addition, height, weight, and subscapular skinfold thickness (SSF) were measured and children performed a run/walk fitness (R/W) test. Gender-specific multiple linear regression assessed the impact of baseline variables on the log of SSF at baseline and follow-up. RESULTS: In cross-sectional analyses among boys and girls, the common correlates of baseline SSF included failing to achieve the minimal fitness standard for the R/W test and being involved in summer sports. Additional correlates identified only among girls included excessive television watching, lower PA, and involvement in community sports. Longitudinal predictors among girls were younger age, being from the comparison community, excessive TV, and PA. Among boys, only baseline SSF predicted follow-up SSF. Girls who watched excessive TV had SSFs 30 and 14% greater than those who watched less TV at baseline and follow-up, respectively. CONCLUSION: TV viewing was the only consistent determinant of adiposity among girls.

Potential health risks of complementary alternative medicines in cancer patients.

Many cancer patients use complementary alternative medicines (CAMs) but may not be aware of the potential risks. There are no studies quantifying such risks, but there is some evidence of patient risk from case reports in the literature. A cross-sectional survey of patients attending the outpatient department at a specialist cancer centre was carried out to establish a pattern of herbal remedy or supplement use and to identify potential adverse side effects or drug interactions with conventional medicines. If potential risks were identified, a health warning was issued by a pharmacist. A total of 318 patients participated in the study. Of these, 164 (51.6%) took CAMs, and 133 different combinations were recorded. Of these, 10.4% only took herbal remedies, 42.1% only supplements and 47.6% a combination of both. In all, 18 (11.0%) reported supplements in higher than recommended doses. Health warnings were issued to 20 (12.2%) patients. Most warnings concerned echinacea in patients with lymphoma. Further warnings were issued for cod liver/fish oil, evening primrose oil, gingko, garlic, ginseng, kava kava and beta-carotene. In conclusion, medical practitioners need to be able to identify the potential risks of CAMs. Equally, patients should be encouraged to disclose their use. Also, more research is needed to quantify the actual health risks.