No / Recent studies have revealed extensive cortical demyelination in patients with progressive multiple sclerosis (MS). Demyelination in gray matter lesions is associated with activation of microglia. Macrophages and microglia are known to express myeloperoxidase (MPO) and generate reactive oxygen species during myelin phagocytosis in the white matter. In the present study we examined the extent of microglial activation in the cerebral cortex and the relationship of microglial activation and MPO activity to cortical demyelination. Twenty-one cases of neuropathologically confirmed multiple sclerosis, with 34 cortical lesions, were used to assess microglial activation. HLA-DR immunolabeling of activated microglia was significantly higher in demyelinated MS cortex than control cortex and, within the MS cohort, was significantly greater within cortical lesions than in matched non-demyelinated areas of cortex. In homogenates of MS cortex, cortical demyelination was associated with significantly elevated MPO activity. Immunohistochemistry revealed MPO in CD68-positive microglia within cortical plaques, particularly toward the edge of the plaques, but not in microglia in adjacent non-demyelinated cortex. Cortical demyelination in MS is associated with increased activity of MPO, which is expressed by a CD68-positive subset of activated microglia, suggesting that microglial production of reactive oxygen species is likely to be involved in cortical demyelination.

Yes / To determine whether jugular venous reflux (JVR) is associated with cerebral white matter changes (WMCs) in individuals with Alzheimer's disease (AD), we studied 12 AD patients 24 mild cognitive impairment (MCI) patients, and 17 elderly age- and gender-matched controls. Duplex ultrasonography and 1.5T MRI scanning was applied to quantify cerebral WMCs [T2 white matter (WM) lesion and dirty-appearing-white-matter (DAWM)]. Subjects with severe JVR had more frequently hypertension (p = 0.044), more severe WMC, including increased total (p = 0.047) and periventricular DAWM volumes (p = 0.008), and a trend for increased cerebrospinal fluid volumes (p = 0.067) compared with the other groups. A significantly decreased (65.8%) periventricular DAWM volume (p = 0.01) in the JVR-positive AD individuals compared with their JVR-negative counterparts was detected. There was a trend for increased periventricular and subcortical T2 WMC lesion volumes in the JVR-positive AD individuals compared with their JVR-negative counterparts (p = 0.073). This phenomenon was not observed in either the control or MCI groups. In multiple regression analysis, the increased periventricular WMC lesion volume and decreased DAWM volume resulted in 85.7% sensitivity and 80% specificity for distinguishing between JVR-positive and JVR-negative AD patients. These JVR-WMC association patterns were not seen in the control and MCI groups. Therefore, this pilot study suggests that there may be an association between JVR and WMCs in AD patients, implying that cerebral venous outflow impairment might play a role in the dynamics of WMCs formation in AD patients, particularly in the periventricular regions. Further longitudinal studies are needed to confirm and validate our findings.

No / To investigate differential item functioning or item bias of the Rivermead Mobility Index (RMI) and its impact on the drawing of valid comparisons with the RMI between subgroups of patients after stroke who differ with respect to age, sex, or side of lesion. DESIGN: Cross-sectional study. SETTING: A rehabilitation center in the Netherlands and 2 stroke rehabilitation units and the wider community in the United Kingdom. PARTICIPANTS: The RMI was completed for patients undergoing rehabilitation after stroke (N=620; mean age +/- SD, 69.2+/-12.5y; 297 [48%] men; 269 [43%] right hemisphere lesion, and 304 [49%] left hemisphere lesion). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Mokken scale analysis was used to investigate differential item functioning of the RMI between subgroups of patients who differed with respect to age (young vs older), sex (men vs women), and side of stroke lesion (right vs left hemisphere). RESULTS: No differential item functioning was found for any of the comparison subgroups. CONCLUSIONS: The RMI allows valid comparisons to be made between subgroups of patients undergoing rehabilitation after stroke who differ with respect to age, sex, or side of lesion.

No / To enable improved interpretation of the total score and faster scoring of the Rivermead Mobility Index (RMI) by studying item ordering or hierarchy and formulating start-and-stop rules in patients after stroke. DESIGN: Cohort study. SETTING: Rehabilitation center in the Netherlands; stroke rehabilitation units and the community in the United Kingdom. PARTICIPANTS: Item hierarchy of the RMI was studied in an initial group of patients (n=620; mean age +/- SD, 69.2+/-12.5y; 297 [48%] men; 304 [49%] left hemisphere lesion, and 269 [43%] right hemisphere lesion), and the adequacy of the item hierarchy-based start-and-stop rules was checked in a second group of patients (n=237; mean age +/- SD, 60.0+/-11.3y; 139 [59%] men; 103 [44%] left hemisphere lesion, and 93 [39%] right hemisphere lesion) undergoing rehabilitation after stroke. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Mokken scale analysis was used to investigate the fit of the double monotonicity model, indicating hierarchical item ordering. The percentages of patients with a difference between the RMI total score and the scores based on the start-and-stop rules were calculated to check the adequacy of these rules. RESULTS: The RMI had good fit of the double monotonicity model (coefficient H(T)=.87). The interpretation of the total score improved. Item hierarchy-based start-and-stop rules were formulated. The percentages of patients with a difference between the RMI total score and the score based on the recommended start-and-stop rules were 3% and 5%, respectively. Ten of the original 15 items had to be scored after applying the start-and-stop rules. CONCLUSIONS: Item hierarchy was established, enabling improved interpretation and faster scoring of the RMI.

Chemerin is a chemoattractant adipokine that regulates adipogenesis and may induce insulin resistance. Chemerin serum concentrations are elevated in obese, insulin-resistant, and inflammatory states in vivo. Here we investigate the role of omental (OM) and subcutaneous (SC) adipose tissue chemerin and CMKLR1 messenger RNA (mRNA) expression in human obesity. In addition, we test the hypothesis that changes in chemerin serum concentrations are primarily associated with reduced body fat mass in the context of 3 weight loss intervention studies. Chemerin serum concentration was measured in 740 individuals in a cross-sectional (n = 629) study including a subgroup (n = 161) for which OM and SC chemerin mRNA expression has been analyzed as well as in 3 interventions including 12 weeks of exercise (n = 60), 6 months of calorie-restricted diet (n = 19) studies, and 12 months after bariatric surgery (n = 32). Chemerin mRNA is significantly higher expressed in adipose tissue of patients with type 2 diabetes mellitus and correlates with circulating chemerin, body mass index (BMI), percentage body fat, C-reactive protein, homeostasis model assessment of insulin resistance, and glucose infusion rate in euglycemic-hyperinsulinemic clamps. CMKLR1 mRNA expression was not significantly different between the 2 fat depots. Obesity surgery–induced weight loss causes a significant reduction on both OM and SC chemerin expression. All interventions led to significantly reduced chemerin serum concentrations. Decreased chemerin serum concentrations significantly correlate with improved glucose infusion rate and reduced C-reactive protein levels independently of changes in BMI. Insulin resistance and inflammation are BMI-independent predictors of elevated chemerin serum concentrations. Reduced chemerin expression and serum concentration may contribute to improved insulin sensitivity and subclinical inflammation beyond significant weight loss.

Chemerin is a chemoattractant adipokine that regulates adipogenesis and may induce insulin resistance. Chemerin serum concentrations are elevated in obese, insulin-resistant, and inflammatory states in vivo. Here we investigate the role of omental (OM) and subcutaneous (SC) adipose tissue chemerin and CMKLR1 messenger RNA (mRNA) expression in human obesity. In addition, we test the hypothesis that changes in chemerin serum concentrations are primarily associated with reduced body fat mass in the context of 3 weight loss intervention studies. Chemerin serum concentration was measured in 740 individuals in a cross-sectional (n = 629) study including a subgroup (n = 161) for which OM and SC chemerin mRNA expression has been analyzed as well as in 3 interventions including 12 weeks of exercise (n = 60), 6 months of calorie-restricted diet (n = 19) studies, and 12 months after bariatric surgery (n = 32). Chemerin mRNA is significantly higher expressed in adipose tissue of patients with type 2 diabetes mellitus and correlates with circulating chemerin, body mass index (BMI), percentage body fat, C-reactive protein, homeostasis model assessment of insulin resistance, and glucose infusion rate in euglycemic-hyperinsulinemic clamps. CMKLR1 mRNA expression was not significantly different between the 2 fat depots. Obesity surgery–induced weight loss causes a significant reduction on both OM and SC chemerin expression. All interventions led to significantly reduced chemerin serum concentrations. Decreased chemerin serum concentrations significantly correlate with improved glucose infusion rate and reduced C-reactive protein levels independently of changes in BMI. Insulin resistance and inflammation are BMI-independent predictors of elevated chemerin serum concentrations. Reduced chemerin expression and serum concentration may contribute to improved insulin sensitivity and subclinical inflammation beyond significant weight loss.

Sparse information is available concerning use of emergency departments (EDs) by the elderly in rural areas. We reviewed records of all patients seeking care at EDs of three rural hospitals during 7 days in October 1991. We found that elderly people did not use EDs in proportion to their numbers in the community (15.2% versus 19.3%). Compared with younger ED patients, more elderly patients required an ambulance (40.8% versus 10.7%), more needed hospitalization (38.4% versus 11.9%), and their ED stays were longer (140 minutes versus 89 minutes). Falls/injuries (18.7%) and cardiac illness (18.1%) were the most frequent reasons for ED visits by the elderly, and relatively few (2.8%) had confusion. More elderly patients arrived during daytime hours than during the night, and more on weekends than weekdays. Also, we found no difference between patients in the 65- to 74-year-old age group and those aged 75 years and older.

<p>Увод. Годишње најмање 30% особа старијих од 65 година доживи један или више падова. Са повећањем година повећава се и озбиљност компликација услед пада, степен функционалног оштећења и ниво инвалидитета. Одговорност за пад приписује се многим факторима ризика. Због сложености њихове природе, од кључног је значаја да се ревидирају концептуални и методолошки оквири за разумевање и предвиђање пада у популацији старих особа. Циљеви истраживања. Утврдити учесталост падова код особа старијих од 65 година; утврдити најзначајније факторе ризика од пада и проценити њихову интеракцију са функционалним способностима и забринутост због пада. Материјал и методологија. Истраживање је спроведено у од фебруара до јуна 2014. године у виду студије пресека и обухватило је 400 испитаника старијих од 65 година. Испитаници су тестирани у кућним условима приликом посете патронажне службе. Коришћени су следећи инструменти: општи упитник, Elderly Fall Screening Test &ndash; ЕFST, Multi-factor Falls Questionnaire &ndash; MFQ, Tinetti Balance Assessment, Lawton Instrumental Activities of Daily Living Scale &minus; IADL, Falls Efficacy Scale International FES-I. Стaтистички прорaчуни су вршени прогрaмом SPSS верзијa 20. Резултати истраживања. Резултати студије показују да је пад доживело 55% испитаника. Регресиони модел EFST са варијаблама био је статистички значајан, а као независни предиктори показали су се женски пол (OR = 2,751; &lt; 0,001), године старости (OR = 1,138; p &lt; 0,001), и степен образовања (OR = 0,554; p = 0,027). Слични резултати су добијении и за регресиони модел са Тинетијевим скором где су се као независни предиктори показали пол (Beta = -0,107; p = 0,029) старост (Beta = -0,260; p &lt; 0,001) и степен образовања (Beta = 0,191; p &lt; 0,001). Све корелације између ЕFST, FESI, IADL и скором Тинетијевог теста биле су статистички значајне (p &lt; 0,05). Вредности скора FESI биле су у јакој позитивној корелацији са скором ЕFST и изузетно негативној корелацији са IADL и скором Тинетијевог теста. Скор ЕFST показао је умерену негативну корелацију са скором IADL и јаку негативну са скором Тинетијевог теста, док су скор IADL и скор Тинетијевог теста показали умерену позитивну корелацију. Модел EFST био је статистички значајан и у целини тачно класификује 83,3% случајева. Варијабле које су се показале као независни предиктори били су: Тинети скор (OR = 0,783; p &lt; 0,001), скор (OR = 1,041; p = 0,019) и ортостатска хипотензија (OR = 2,291; p = 0,035). Закључак. У испитиваној популацији падови су веома учестала појава и више од половине особа доживела је пад у последњих годину дана. У повећаном ризику од пада су жене. Такође ризик од пада повећава се са годинама старости. Нижи степен образовања показао се као независни предиктор пада. Предикција ризика од пада утврђеног на основу скрининг тест за пад код старих особа у општој популацији могућа је уз висок степен детерминације на основу скора Тинетијевог теста и, скора FESI и ортостатске хипотензије.</p> / <p>Uvod. Godišnje najmanje 30% osoba starijih od 65 godina doživi jedan ili više padova. Sa povećanjem godina povećava se i ozbiljnost komplikacija usled pada, stepen funkcionalnog oštećenja i nivo invaliditeta. Odgovornost za pad pripisuje se mnogim faktorima rizika. Zbog složenosti njihove prirode, od ključnog je značaja da se revidiraju konceptualni i metodološki okviri za razumevanje i predviđanje pada u populaciji starih osoba. Ciljevi istraživanja. Utvrditi učestalost padova kod osoba starijih od 65 godina; utvrditi najznačajnije faktore rizika od pada i proceniti njihovu interakciju sa funkcionalnim sposobnostima i zabrinutost zbog pada. Materijal i metodologija. Istraživanje je sprovedeno u od februara do juna 2014. godine u vidu studije preseka i obuhvatilo je 400 ispitanika starijih od 65 godina. Ispitanici su testirani u kućnim uslovima prilikom posete patronažne službe. Korišćeni su sledeći instrumenti: opšti upitnik, Elderly Fall Screening Test &ndash; EFST, Multi-factor Falls Questionnaire &ndash; MFQ, Tinetti Balance Assessment, Lawton Instrumental Activities of Daily Living Scale &minus; IADL, Falls Efficacy Scale International FES-I. Statistički proračuni su vršeni programom SPSS verzija 20. Rezultati istraživanja. Rezultati studije pokazuju da je pad doživelo 55% ispitanika. Regresioni model EFST sa varijablama bio je statistički značajan, a kao nezavisni prediktori pokazali su se ženski pol (OR = 2,751; &lt; 0,001), godine starosti (OR = 1,138; p &lt; 0,001), i stepen obrazovanja (OR = 0,554; p = 0,027). Slični rezultati su dobijenii i za regresioni model sa Tinetijevim skorom gde su se kao nezavisni prediktori pokazali pol (Beta = -0,107; p = 0,029) starost (Beta = -0,260; p &lt; 0,001) i stepen obrazovanja (Beta = 0,191; p &lt; 0,001). Sve korelacije između EFST, FESI, IADL i skorom Tinetijevog testa bile su statistički značajne (p &lt; 0,05). Vrednosti skora FESI bile su u jakoj pozitivnoj korelaciji sa skorom EFST i izuzetno negativnoj korelaciji sa IADL i skorom Tinetijevog testa. Skor EFST pokazao je umerenu negativnu korelaciju sa skorom IADL i jaku negativnu sa skorom Tinetijevog testa, dok su skor IADL i skor Tinetijevog testa pokazali umerenu pozitivnu korelaciju. Model EFST bio je statistički značajan i u celini tačno klasifikuje 83,3% slučajeva. Varijable koje su se pokazale kao nezavisni prediktori bili su: Tineti skor (OR = 0,783; p &lt; 0,001), skor (OR = 1,041; p = 0,019) i ortostatska hipotenzija (OR = 2,291; p = 0,035). Zaključak. U ispitivanoj populaciji padovi su veoma učestala pojava i više od polovine osoba doživela je pad u poslednjih godinu dana. U povećanom riziku od pada su žene. Takođe rizik od pada povećava se sa godinama starosti. Niži stepen obrazovanja pokazao se kao nezavisni prediktor pada. Predikcija rizika od pada utvrđenog na osnovu skrining test za pad kod starih osoba u opštoj populaciji moguća je uz visok stepen determinacije na osnovu skora Tinetijevog testa i, skora FESI i ortostatske hipotenzije.</p> / <p>Introduction. Annually at least 30% of people over 65 experience one or more falls. With the increase in years, the severity of complications due to falls, degree of functional impairment and level of disability also increase. The responsibility for the fall is attributed to many risk factors. Due to the complexity of their nature, it is crucial that the conceptual and methodological frameworks for understanding and predicting the decline in the elderly population are revised. Research goals. Determine the incidence of falls in people over 65 years of age; identify the most important risk factors of the fall and evaluate their interaction with functional abilities and fear for falling. Material and methodology. The survey was conducted from February to June 2014 in the form of a cross sectional study and included 400 respondents over 65 years of age. Respondents were tested at home during a visit of the patronage service. The following instruments were used: general questionnaire, Elderly Fall Screening Test - EFST, Multi-factor Falls Questionnaire - MFQ, Tinetti Balance Assessment, Lawton Instrumental Activities of Daily Living Scale - IADL, Falls Efficacy Scale International FES-I. Statistical calculations were performed by the SPSS version 20 program. Research results. The results of the study show that the fall was experienced by 55% of respondents. The regression model EFST with variables was statistically significant, and as independent predictors the female sex (OR = 2,751; &lt;0,001), age (OR = 1,138; p &lt;0,001), and the level of education (OR = 0,554; p = 0.027) were shown. Similar results were obtained for the regression model with the Tinetti&#39;s score, where the gender (Beta = -0.107; p = 0.029) age (Beta = -0.260; p &lt;0.001) and education (Beta = 0.191; p &lt; 0.001) were shown as independent predictors. All correlations between EFST, FESI, IADL and the Tinetti&#39;s test score were statistically significant (p &lt;0.05). The FESI score values were in a strong positive correlation with the EFST score and extremely negative correlation with IADL and the Tinetti&rsquo;s test score. The EFST score showed a moderate negative correlation with the IADL score and a strong negative with the Tinetti&rsquo;s test score, while the IADL score and the Tinetti test score showed moderate positive correlation. The EFST model was statistically significant and in its entirety accurately classified 83.3% of cases. Variables that proved to be independent predictors were: Tinetti score (OR = 0.783; p &lt;0.001), score (OR = 1.041; p = 0.019) and orthostatic hypotension (OR = 2.291; p = 0.035). Conclusion. In the studied population, falls are a very common occurrence and more than half of the people experienced a fall in the past year. Women are at increased risk of falling. Also, the risk of falling increases with age. A lower level of education has proven to be an independent fall predictor. Prediction of the risk of a fall that has been established on the basis of a screening test for elderly people in the general population is possible with a high degree of determination based on the Tinetti test score and, recent FESI and orthostatic hypotension.</p>

The literature directly comparing the epidemiology of MRSA among adult and pediatric hospitalized patients is strikingly minimal. The objective of this thesis was to identify any differences between these two patient groups. The Canadian Nosocomial Infections Surveillance Program MRSA data (1995 to 2007: n=1,262 pediatric and 35,907 adult cases) were used to compare MRSA clinical and molecular characteristics and rates. Hospital characteristics were modeled using repeated measures Poisson regressions. The molecular and epidemiological characteristics of MRSA differed significantly between adults and children. Compared to children, MRSA in adults was more likely to be healthcare-associated, colonization, SCCmec type II, PVL negative, and resistant to most antibiotics. Rates of MRSA in Canada increased in both populations over time but were significantly higher in adults. The hospital characteristics associated with increased MRSA rates differed in adult and pediatric facilities. Implications for infection prevention and control strategies are discussed.

The literature directly comparing the epidemiology of MRSA among adult and pediatric hospitalized patients is strikingly minimal. The objective of this thesis was to identify any differences between these two patient groups. The Canadian Nosocomial Infections Surveillance Program MRSA data (1995 to 2007: n=1,262 pediatric and 35,907 adult cases) were used to compare MRSA clinical and molecular characteristics and rates. Hospital characteristics were modeled using repeated measures Poisson regressions. The molecular and epidemiological characteristics of MRSA differed significantly between adults and children. Compared to children, MRSA in adults was more likely to be healthcare-associated, colonization, SCCmec type II, PVL negative, and resistant to most antibiotics. Rates of MRSA in Canada increased in both populations over time but were significantly higher in adults. The hospital characteristics associated with increased MRSA rates differed in adult and pediatric facilities. Implications for infection prevention and control strategies are discussed.