Fall-Related Hospitalizations in Elderly People: Temporal Trend and Spatial Distribution in Brazil.

This study aims to identify the temporal variation and the spatial dependence structure of the hospitalization rate for falls in the elderly residing in Brazil in the period between 2010 and 2021. This ecological study employs secondary data from the Brazilian Ministry of Health about the fall-related hospitalization of people aged 60 years old and over. A time-series analysis was carried out, employing the joinpoint model. For the spatial analysis, the Moran autocorrelation technique was employed. In Brazil, between 2010 and 2021, there were 1,270,341 hospitalizations for falls recorded among the elderly in the Brazilian Hospitalization System. There was a continuous upward trend between 2010 and 2019 for all age groups, female and male, and all Brazilian regions. The trend stabilized between 2019 to 2021. The North and Northeast regions had faster upward trends among all Brazilian regions, and there was also a faster upward trend among women compared to men. A high-high pattern in hospitalization incidence was noticed from 2011 to 2019 in the states of São Paulo, Minhas Gerais, Paraná, and Mato Grosso do Sul. The results of this study provide subsidies for Brazilian health authorities to implement more efficient public policies to improve the quality of life of elderly people.

Time course of dorsolateral geniculate nucleus plasticity in adult monkeys with laser-induced retinal lesions.

We studied changes in the expression of growth-associated protein 43 (GAP43), glial fibrillary acidic protein (GFAP), and calcium-binding proteins (calbindin [Cb] and parvalbumin [Pv]) in the dorsal lateral geniculate nucleus (dLGN) of four capuchin monkeys with laser-induced retinal lesions. The lesions were generated with the aid of a neodymium-YAG dual-frequency laser with shots of different intensity and at different survival time in each animal. The expression of these proteins in the layers of the dLGN was evaluated by performing histodensitometry of coronal sections throughout the nucleus. High-power laser shots administered at the border of the optic disc (OD)-injured fibers resulted in large scotomas. These lesions produced a devastating effect on fibers in this passage, resulting in large deafferentation of the dLGN. The time course of plasticity expressed in this nucleus varied with the degree of the retinal lesion. Topographically, corresponding portions of the dLGN were inferred by the extent of the ocular dominance column revealed by cytochrome oxidase histochemistry in flattened preparations of V1. In the region representing the retinal lesion, the expression of GFAP, GAP43, Pv, and Cb increased and decreased in the corresponding dLGN layers shortly after lesion induction and returned to their original values with different time courses. Synaptogenesis (indicated by GAP43 expression) appeared to be increased in all layers, while "cleansing" of the glial-damaged region (indicated by GFAP expression) was markedly greater in the parvocellular layers, followed by the magnocellular layers. Schematic drawings of optic discs laser lesions and of series of coronal sections of the dLGN, in three monkeys, depicting the areas of the nucleus deafferented by the lesions.

Principal component analysis approach for comprehensive screening of salt stress-tolerant tomato germplasm at the seedling stage.

Salt stress is a major abiotic factor that affects the growth and yield of crops. The present study was carried out to assess the salt tolerance among the Arka Samrat, Arka Rakshak, YVU-1, S-22, YVU-2, and PKM-OP tomato germplasms using principal component analysis (PCA). Different salt (NaCl) concentrations like control, 0.04 M, 0.12 M, and 0.20 M were selected in order to classify them into sensitive and tolerant tomato germplasms based on 13 parameters. A significant variation was observed among the selected tomato germplasms towards salinity tolerance at the seedling stage. Shoot length, root length, fresh weight, and dry weight parameters of the seedlings were decreased linearly with an increase in the external NaCl concentration. Salinization of plants has shown to reduce K+ content and increase in the Na+ accumulation, Ca2+, and Catalase activity. Salt stress also increased electrolyte leakage and reduced relative water content of all germplasms. The maximum parameters were less affected in Arka Rakshak and Arka Samrat compared to the remaining germplasms at higher salt stress. The PCA analysis of 13 morphological and physiological variables indicated that Arka Rakshak and Arka Samrat germplasms were salt-tolerant and PKM-OP was susceptible. Thus PCA analysis results are useful for the identification of resistance and sensitive germplasms at the seedling stage.

Preserving US microbe collections sparks future discoveries.

Collections of micro-organisms are a crucial element of life science research infrastructure but are vulnerable to loss and damage caused by natural or man-made disasters, the untimely death or retirement of personnel, or the loss of research funding. Preservation of biological collections has risen in priority due to a new appreciation for discoveries linked to preserved specimens, emerging hurdles to international collecting and decreased funding for new collecting. While many historic collections have been lost, several have been preserved, some with dramatic rescue stories. Rescued microbes have been used for discoveries in areas of health, biotechnology and basic life science. Suggestions for long-term planning for microbial stocks are listed, as well as inducements for long-term preservation.

Differential Synaptic and Extrasynaptic Glutamate-Receptor Alterations in Striatal Medium-Sized Spiny Neurons of Aged YAC128 Huntington's Disease Mice.

Huntington's disease (HD) is a late-onset, slowly progressing neurodegenerative disorder caused by an expansion of glutamine repeats. The YAC128 mouse model has been widely used to study the progression of HD symptoms, but little is known about synaptic alterations in very old animals. The present experiments examined synaptic properties of striatal medium-sized spiny neurons (MSNs) in 16 month-old YAC128 mice. These mice were crossed with mice expressing enhanced green fluorescent protein (EGFP) under the control of either D1 or D2 dopamine receptor promoters to identify MSNs originating the direct and indirect pathways, respectively. The input-output curves of evoked excitatory postsynaptic currents mediated by activation of the α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA) or N-methyl-D-aspartate (NMDA) receptors were reduced in MSNs in both pathways. In the presence of DL-threo-ß-Benzyloxyaspartic acid (DL-TBOA), a glutamate transporter blocker used to increase activation of extrasynaptic receptors, NMDA receptor-mediated currents displayed altered amplitudes, longer decay times, and greater charge (response areas) in both direct and indirect pathway MSNs in YAC128 mice compared to wildtype controls. Amplitudes were significantly increased, primarily in direct pathway MSNs while normalized areas were significantly increased only in indirect pathway MSNs, suggesting that the two types of MSNs are affected in different ways. It may be that indirect pathway neurons are more susceptible to changes in glutamate transport. Taken together, the present findings demonstrate differential alterations in synaptic versus extrasynaptic NMDA receptors in both direct and indirect pathway MSNs in late HD, which may contribute to the dysfunction and degeneration in both pathways.

Quantification of early stages of cortical reorganization of the topographic map of V1 following retinal lesions in monkeys.

We quantified the capacity for reorganization of the topographic representation of area V1 in adult monkeys. Bias-free automated mapping methods were used to delineate receptive fields (RFs) of an array of neuronal clusters prior to, and up to 6 h following retinal lesions. Monocular lesions caused a significant reorganization of the topographic map in this area, both inside and outside the cortical lesion projection zone (LPZ). Small flashed stimuli revealed responses up to 0.85 mm inside the boundaries of the LPZ, with RFs representing regions of undamaged retina immediately surrounding the lesion. In contrast, long moving bars that spanned the scotoma resulting from the lesion revealed responsive units up to 1.87 mm inside the LPZ, with RFs representing interpolated responses in this region. This reorganization is present immediately after monocular retinal lesioning. Both stimuli showed a similar and significant (5-fold) increase of the RF scatter in the LPZ, 0.56 mm (median), compared with the undamaged retina, 0.12 mm. Our results reveal an array of preexisting subthreshold functional connections of up to 2 mm in V1, which can be rapidly mobilized independently from the differential qualitative reorganization elicited by each stimulus.

A new score to predict post operative complications after endovascular treatment of thoraco abdominal aortic aneurysms.

BACKGROUND: The endovascular treatment of thoraco abdominal aortic aneurysms (TAAA) is a minimally invasive solution. However, patient selection remains a major problem. We have analysed our experience to identify the risk factors for post-operative morbidity and mortality and to construct a scoring system to identify those patients likely to benefit from this treatment. METHODS: We have analysed a consecutive cohort of patients treated electively for TAAA using endovascular techniques between 2006 and October 2012. All data were collected prospectively. The risk factors associated with spinal cord ischemia (SCI), the need for post-operative dialysis and 30 day mortality were determined using multivariate statistical techniques and a logistic regression model including all variables that were significant on univariate analysis (p < 0.05). A predictive score was calculated using a Received Operating Characteristic (ROC) curve, defining best specificity and sensibility. RESULTS: We analysed the data from 123 patients (median age 70 years). The 30 day mortality rate was 8% (10 patients). The SCI rate was 6% (7 patients). One patient (1%) required long-term dialysis after the aortic procedure. The cumulative early mortality, SCI and permanent dialysis rate was 14% (17 patients). In multivariate analysis, adverse outcome was associated with advanced age (OR = 1.110 ; p = 0.022), and Crawford type I or II or III (OR = 9.292 ; p = 0.002) as compared with Crawford type IV. Pre-operative beta blocker (BB) treatment was a protective factor (OR = 0.099 ; p = 0.005). A predictive score was then constructed : Score = -10.060 + 0.104x(A) +2.229x(B) -2.315x(C) (A = patient age ; B = 1 if TAAA Crawford type 1, 2 or 3, 0 if TAAA type 4 ; C = 1 if on-going BB treatment (30 days pre-surgery minimum), 0 if none). Its sensitivity and specificity were 88% and 89% respectively. CONCLUSIONS: We propose a simple predictive scoring system. This tool is useful in predicting the most feared complications after endovascular TAAA repair and has potential use in the identification and counselling of vulnerable patients being considered for surgery. More data are needed to refine the prediction of individual operative risks.

Homodimeric pregnancy-associated plasma protein-A in normal human placenta of first and third trimester of pregnancy: biochemical and morphological observations.

Insulin-like growth factors (IGFs) become bio-available following hydrolysis of binding proteins by homodimeric PAPP-A (dPAPP-A); this is a metzincin associated with the membranes of trophoblast phenotypes, the precise placental localization of which was unknown. Our study on placental samples of the first trimester shows the immunohistochemical localization of proMBP and dPAPP-A in the same cells. In contrast, dPAPP-A is mainly negative in the syncytium (ST) and positive in the villous cytotrophoblast (VCT) while htPAPP-A is strongly expressed in the ST and negative in the VCT at term, suggesting a progressive deactivation of the enzyme with gestational age. In agreement with the above, dPAPP-A is released only by first trimester placental explants in culture.

Diagnosis and management of prosthetic vascular graft infections.

Prosthetic vascular graft infection is a rare but very severe complication with a high death rate. Its optimal management requires appropriate surgical procedures combined with adequate antimicrobial treatment in reference center. The authors wanted to focus on the management of prosthetic vascular graft infection and define the clinical, microbiological, biological, and radiological criteria of vascular graft infection. Complementary investigations, although these are small series, include CT scan, the gold standard for the diagnosis of acute infection with a sensitivity and specificity reaching 100%, but decreased to 55% in case of chronic infection. More recently, PET-scanning was studied and yielded good results in chronic infections (sensitivity 98%, specificity 75.6%, positive predictive value 88.5%, and negative predictive value 84.4%). Managing prosthetic vascular graft infection, as with the orthopedic and vascular infections, requires replacing the vascular prosthesis. There is no correlation between the microbiological data and the location or type of vascular infection. Thus, the postoperative intravenous antibiotherapy should be bactericidal with a broad-spectrum. After obtaining intra-operative microbiological results, de-escalation therapy must include at least one anti-adherence agent, such as rifampicin in staphylococcal infections.

Characteristics and prognosis in patients with prosthetic vascular graft infection: a prospective observational cohort study.

Prosthetic vascular graft infection (PVGI) is a devastating complication, with a mortality rate of up to 75%, which is especially caused by aortic graft infection. The purpose of this study was to evaluate factors associated with in-hospital mortality of patients with definite graft infection, and with long-term outcome. We reviewed medical records of 85 patients treated for PVGIs defined by positive bacterial culture of intraoperative specimens or blood samples, and/or clinical, biological and radiological signs of infection. In-hospital patient mortality was defined as any death occurring during the initial treatment of the graft infection. Cure was defined as the absence of evidence of relapsing infection during long-term follow-up (≥1 year). Eighty-five patients (54 aortic and 31 limb graft infections) treated by surgical debridement and removal of the infected prosthesis (n=41), surgical debridement without removal of prosthesis (n=34) or antimicrobial treatment without surgery (n=10) were studied. The only microbiological difference observed between patients with early (occurring within 4 months after surgery) vs. late PVGI and between those with aortic vs. limb PVGI was the incidence of PVGI caused by Staphylococcus aureus, which was greater in patients with limb PVGI. Overall cure was observed in 93.2% of 59 patients with a follow-up of a minimum of 1 year. Overall in-hospital mortality was 16.5% (n=14). Two variables were independently associated with mortality: age >70 years (OR 9.1, 95% CI 1.83-45.43, p 0.007) and aortic graft infection (OR 5.6, 95% CI 1.1-28.7, p 0.037).

Hepatorenal bypass allowing fenestrated endovascular repair of juxtarenal abdominal aortic aneurysm: a case report.

A 61-year-old man presented with a 66-mm juxtarenal aortic aneurysm. He was unfit for open repair. The anatomical proximity of his right renal artery (RRA) and his superior mesenteric artery (SMA) precluded fabrication of an endograft allowing perfusion of both vessels. He underwent a hepato-renal bypass to his RRA and subsequent fenestrated endovascular aneurysm repair (EVAR) using an endoprosthesis with fenestrations for the SMA and the left renal artery (LRA), and a scallop for the coeliac trunk. Follow-up imaging showed all visceral vessels to be perfused. The use of this limited hybrid approach allows endovascular treatment of aneurysms that are initially unsuitable for such an approach.

Endovascular repair of thoracoabdominal aortic aneurysms.

OBJECTIVES: To evaluate the early outcomes following thoracoabdominal aortic aneurysm (TAAA) repair utilising fenestrated and branched endografts. DESIGN AND MATERIALS AND METHODS: A prospective analysis of all patients undergoing endovascular repair of TAAA in a single academic centre. All patients were deemed unfit for open surgical repair. Customised endografts were designed using CT data reconstructed on 3D workstations. Post-operatively all patients were evaluated radiologically at hospital discharge, at 6, 12, 18 and 24 months, and annually thereafter. RESULTS: Thirty-three consecutive patients (30 males) were treated over 33 months (August 2006 to April 2009). Median age and aneurysm size were 70 years (range 50-83 years) and 64 mm (range 55-100 mm) respectively. 114/116 (98%) of the targeted visceral vessels were successfully catheterised and perfused. The in-hospital mortality rate was 9% (3/33). Transient spinal cord ischaemia was diagnosed in 4/33 (12%) patients, and permanent paraplegia in one (3%). The median follow-up period was 11 months (range 1-33 months). Endoleaks were identified in 5/33 (15%) patients: type II in four patients and a type III endoleak in one patient which required the only secondary intervention. During follow-up, two patients died: one from stroke and the other from myocardial infarction 9 and 29 months respectively after the procedure. CONCLUSION: This preliminary study, which includes our learning curve, confirms the feasibility and safety of the endovascular repair of TAAA in high-risk patients. Meticulous follow-up to assess sac behaviour and visceral perfusion is critical in order to ensure optimal results of these complex endovascular repairs requiring numerous mating components.

Endovascular thoracoabdominal aortic aneurysm repair: a literature review of early and mid-term results.

Successful endovascular repair of abdominal aortic aneurysms (AAA) requires undilated proximal (infrarenal neck) and distal landing zones (common or external iliac arteries). A range of approved endografts are available to exclude such aneurysms. Recent multicentric prospective randomized trials have demonstrated a short and midterm decrease in aneurysm-related deaths of the endovascular technique compared to open surgery. These results have induced an overall increase in the rate of endovascular repair of AAA. Patients with more complex aortic aneurysms, involving the visceral vessels (juxta, para and thoraco-abdominal aneurysms (TAAA), have increased perioperative morbidity and mortality after open repair compared to AAA. These patients could potentially benefit from an endovascular approach. Branched and fenestrated endografts have been developed to address this endovascular challenge. This review was carried out on the current literature evaluating these new endovascular complex procedures. Spinal cord ischemia, 30-day mortality and branch patency rates after endovascular exclusion of TAAA ranged from 2.7% to 20%, 0% to 9.1% and 96% to 100% respectively. Mid-term results of endovascular complex aortic repairs are favourable compared to open surgery in high risk patients. Long-term results will be necessary to evaluate specific complications such as migration, material fatigue and component separation that can result in loss of visceral branches.

Zenith abdominal aortic aneurysm endovascular graft: a literature review.

The early experience of endovascular aneurysm repair (EVAR) using ''first generation'' devices was disappointing. There was an appreciable incidence of delayed, post-EVAR, aneurysm rupture. This was primarily a consequence of structural device failure. These failures provided important lessons for re-design and the modern ''second generation'' devices, including the Zenith (Cook Inc, Bloomington, IN, USA) endograft, are thought to be more reliable, particularly providing better fixation and sealing and also a more durable stent/fabric structure. This article comprises a review of the English literature detailing the endovascular treatment of abdominal aortic aneurysms using the Zenith endograft. It focuses on clinical studies or trials with intermediate to long-term follow-up, and related the literature to our own experience. In the series examined (N.=2 017 patients) the early mortality rate ranged from 0% to 4.1% and the technical success rate from 97.7% to 100%. The re-intervention rate was related to the length of follow-up (6.8% to 14%). Conversion rates were consistently <1%. There was a low incidence of device migration, limb thrombosis, component separation and stent fracture. These data support the ongoing use of the Zenith endovascular graft in patients with abdominal aortic aneurysms suitable for EVAR.

Ageing with HIV: newly diagnosed older adults in Italy.

The prevalence of HIV/AIDS among people in midlife and late adulthood has been increasing in Western countries over the last decade. We analyzed data from a prospective, observational multi-centre study on individuals newly diagnosed with HIV between January 2004 and March 2007 in 10 public counselling and testing sites in Latium, Italy. At diagnosis, routine demographic, epidemiological, clinical and laboratory data are recorded, and patients are asked to complete a questionnaire investigating socio-demographic and psycho-behavioural aspects. To analyze the association of individual characteristics with age, we compared older adults (> or = 50 years) with their younger counterpart (18-49 years). To adjust for potential confounding effect of the epidemiological, clinical and behavioural characteristics, to identify factors associated with older age at HIV diagnosis, multivariate logistic regression analysis was performed. Overall, 1073 individuals were identified, 125 of whom (11.6%) were aged 50 years or above. The questionnaire was completed by 41% (440/1073). Compared with their younger counterparts, a higher proportion of older patients were males, born in Italy, reported heterosexual or unknown HIV risk exposure, were never tested for HIV before and were in a more advanced stage of HIV infection at diagnosis. In addition, older adults had a lower educational level and were more frequently living with their partners or children. With respect to psycho-behavioural characteristics, older patients were more likely to have paid money for sex and have never used recreational drugs. Interestingly, no differences were found regarding condom use, which was poor in both age groups. These findings may have important implications for the management of older adults with HIV, who should be targeted by appropriate public health actions, such as opportunistic screening and easier access to healthcare. Moreover, strategies including information on HIV and prevention of risk behaviours are needed.

Cancer cell permeability-glycoprotein as a target of MDR reverters: possible role of novel dihydropyridine derivatives.

The overexpression of permeability-glycoprotein (P-gp) and other drug transporters (ATP-binding cassette) confers a multidrug resistance (MDR) phenotype on cells in various diseases, including many forms of cancer. Development of MDR is one of the main reasons of failure in malignant tumour chemotherapy, as tumour cells, by increasing drug efflux, acquire cross-resistance to many structurally and functionally unrelated anticancer agents, which therefore never achieve effective intracellular concentrations. Endeavouring to find MDR-reverters is a crucial task for exploring new anti-cancer therapeutic intervention. Although many P-gp inhibitors have so far been identified, it is widely recognised that their interaction with P-gp is a complex process and, presently, the details of the mechanisms of action are still a matter of debate. These compounds turned out, however, to be of limited clinical usefulness owing to their inherent pharmacological activities (first generation compounds) and their accessory, inhibiting activity on CYP enzyme system (second generation compounds). Moreover, recent advances of the knowledge on P-gp structure and function and on the mechanisms of P-gp inhibition will prove fruitful for the development of novel therapeutically effective P-gp inhibitors. A dibenzoyl-1,4-dihydropyridine compound (DP7) has been shown to be a powerful P-gp inhibitor, almost devoid of cardiovascular effects, but capable of inhibiting liver CYP3A. DP7 is considered a lead compound for the development of novel dihydropyridines which do not affect CYP enzyme system but still retain the activity towards ABC-efflux transporters.

Cortical visual areas in monkeys: location, topography, connections, columns, plasticity and cortical dynamics.

The visual system is constantly challenged to organize the retinal pattern of stimulation into coherent percepts. This task is achieved by the cortical visual system, which is composed by topographically organized analytic areas and by synthetic areas of the temporal lobe that have more holistic processing. Additional visual areas of the parietal lobe are related to motion perception and visuomotor control. V1 and V2 represent the entire visual field. MT represents only the binocular field, and V4 only the central 30 degrees-40 degrees. The parietal areas represent more of the periphery. For any eccentricity, the receptive field grows at each step of processing, more at anterior areas in the temporal lobe. Minimal point image size increases towards the temporal lobe, but remains fairly constant toward the parietal lobe. Patterns of projection show asymmetries. Central V2 and V4 project mainly to the temporal lobe, while peripherals V2 (more than 30 degrees) and V4 (more than 10 degrees) also project to the parietal lobe. Visual information that arrives at V1 projects to V2, MT and PO, which then project to other areas. Local lateral propagation and recursive loops corroborate to perceptual completion and filling in. Priority connections to temporal, parietal and parieto-temporal cortices help construct crude early representations of objects, trajectories and movements.

Differential expression of Zif268 and c-Fos in the primary visual cortex and lateral geniculate nucleus of normal Cebus monkeys and after monocular lesions.

The transcription factors c-Fos and Zif268 have been used as markers of neuronal activity, and they also have been implicated in neuronal plasticity. In this study, we investigated the expression of c-Fos and Zif268 proteins in the lateral geniculate nucleus (LGN) and in the cortical primary visual area (V1) of normal adult Cebus apella monkeys and in animals with monocular lesions. In the LGN, the reaction for c-Fos showed immunopositive cells in both magnocellular (M) and parvocellular (P) layers; however, the label was heavier in P layers. In animals that suffered monocular lesions, the immunocytochemistry for c-Fos showed more labeling in layers related to the normal eye compared with those of the lesioned eye. No specific label was observed after the reaction for Zif268 in the LGN. In V1, the reaction for both Zif268 and c-Fos showed a pattern of lamination in which heavier labeling was found in layers 2/3, 4A, 4C, and 6. After monocular lesions, we observed a clear pattern of ocular dominance columns in V1 for both c-Fos and Zif268, in which the columns related to the normal eye are more heavily labeled than those related to the lesioned eye. This pattern is more evident in layer 4C after c-Fos reaction, whereas, after Zif268, it is more clearly observed in layers 2/3. These results suggest that, in addition to be regulated by functional activity, these transcription factors are involved in different processes during cortical reorganization.

Effects of oral nutritional supplementation on the intestinal mucosa of patients with AIDS.

Weight loss is a major component of the clinical syndrome in patients with acquired immunodeficiency syndrome (AIDS). The impact of malnutrition on the outcome of the disease has been unappreciated in many investigations. The authors evaluated the effects of oral nutritional supplementation on the morphology and immunology of the intestinal mucosa of patients with AIDS. Twelve patients with AIDS without diarrhea or opportunistic infections, with at least 10% of body weight loss over 1 year, were submitted to anthropometric measures, peripheral blood T-lymphocyte counts, and peroral jejunal biopsy before and after oral nutritional supplementation. An industrialized peptide-based formula containing omega-3 fatty acids was given for 6 weeks. Jejunal samples were analyzed by histomorphometry, including villous-to-crypt ratio, lamina propria, and intraepithelial lymphocyte count. Immunologic assessment of the intestinal mucosa was made by indirect immunoperoxidase using monoclonal antibodies against CD3, CD4, and CD8. Seven patients with irritable bowel syndrome and two healthy volunteers were selected as a control group for histologic and immunohistochemical comparisons. After 6 weeks the patient group maintained their body weight and increased their tricipital fold. The number of peripheral blood T cells, albumin, transferrin, and the number of CD3+, CD4+, and CD8+ cells in jejunal mucosa as well as the intestinal morphometry remained stable. Oral supplementation contributed to maintaining body weight and may constitute a reasonable adjuvant therapeutic tool against AIDS progression.