MPI
Mannose-6-phosphate isomerase (EC 5.3.1.8) (Phosphohexomutase) (Phosphomannose isomerase) (PMI) [PMI1]
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We aim to determine whether lymphatic drainage from the eye changes with age. Using quantitative photoacoustic tomography, groups of young and older mice were studied in the live state. 10 CD-1 mice of 2-3 months (5M/5F) were studied in addition to 13 older mice of 12-13 months (6M/7F). In each of 23 mice, near-infrared tracer (a near-infrared dye, QC-1 conjugated with Bovine Serum Albumin) was injected into the right eye, and imaging of ipsilateral cervical lymph nodes was performed with laser pulses at 11 different wavelengths prior to and 20 min, 2, 4 and 6 h after injection. Mean pixel intensities (MPIs) of nodes were calculated at each imaging session. The areas under the curves (AUC) were calculated for both groups of mice and compared using the t-test. The slopes of MPI of each region of interest were compared using the linear mixed model before and after adjusting for sex, body weight and intraocular pressure of the right eye. The mean intraocular pressure of right eyes before injection was similar in older and younger groups (12.77 ± 2.01 mmHg and 12.90 ± 2.38 mmHg, respectively; p = 0.888). In each mouse, the photoacoustic signal was detected in the right cervical lymph nodes at the 2-h time point following tracer injection into the right eye. At the 4 and 6 h imaging times, a steady increase of tracer signal was observed. Areas under the curve in the right cervical nodes were decreased significantly in older mice compared to younger mice (p = 0.007). The slopes of MPI in the nodes were significantly decreased in old mice compared to young mice both before and after adjusting for sex, body weight and intraocular pressure of the right eye (p = 0.003). In conclusion, lymphatic drainage from the eye is significantly reduced in older eyes. This finding suggests that impaired lymphatic clearance of aqueous humor, proteins and antigens from the eye may contribute to age-related disease of the eye such as glaucoma and inflammatory eye disease.
Keywords
- Age-related
- Aging
- Aqueous humor
- Drainage
- Eye
- Glaucoma
- Imaging
- In vivo
- Lymph node
- Lymphatic
- Mice
- Photoacoustic tomography
- Uveoscleral
The collection of prognostic information in the elderly is essential. The main objective was to perform a replication of the multidimensional prognostic index (MPI), to predict mortality at one-year in patients hospitalized in geriatric wards. Secondary objectives were to evaluate if the MPI was predictive of the length of hospital stay, and of rehospitalization in the following year. Prospective study conducted from February 2015 to November 2016 at the University Hospital of Poitiers (Geriatrics department). A comprehensive geriatric assessment (number of treatment, lifestyle, autonomy, comorbidities, risk of pressure sore, nutritional and cognitive status) was used to calculate the MPI score and to categorize patients into three groups: low (MPI-1), moderate (MPI-2) and high (MPI-3) risk of mortality. 153 patients were included, with mean age 85.9 ± 5.4 years. Twenty-one patients (13.7%) belonged to MPI-1 group, 98 (64.1%) to MPI-2 group, and 34 (22.2%) to MPI-3 group. The number of deaths at one-year according to the MPI group was different (p < 0.01). The one-year prognostic performance of MPI was good (AUC at 0.76). MPI was also predictive of hospital length stay (p < 0.05). MPI appears to be a relevant prognostic tool in the stratification of one-year mortality risk in elderly patients hospitalized in geriatrics.
MeSH Terms
- Aged, 80 and over
- Female
- Geriatric Assessment
- Hospital Mortality
- Hospitalization
- Humans
- Length of Stay
- Male
- Patient Readmission
- Prognosis
Keywords
- elderly
- geriatrics
- hospitalization
- multidimensional prognostic index
La réduction des médicaments potentiellement inappropriés (MPI) chez les personnes âgées est un enjeu important selon de nombreux cliniciens et chercheurs à travers le monde, car ces médicaments accroissent significativement la morbidité et la mortalité dans la population plus âgée. La prévalence des MPI est un problème répandu malgré l'existence de plusieurs critères explicites et implicites de réduction des MPI chez les personnes âgées, les plus courants étant les critères de Beers, les critères STOPP/START et plusieurs critères nationaux spécifiques. Cette revue non systématique visait à examiner les critères de référence pour la réduction des MPI et à clarifier le rôle de certaines mesures, dont la déprescription, pour optimiser la prescription des médicaments chez les personnes âgées. Des recherches par mots-clés et termes MeSH ont été menées dans des bases de données électroniques. Les nombreux critères disponibles ont chacun leurs avantages et inconvénients. La déprescription, qui vise à réduire l'utilisation des MPI, a considérablement gagné en importance dans les initiatives associées à l'amélioration des pratiques de prescription. La déprescription est une approche méthodique qui implique l'arrêt graduel, éclairé et individualisé des médicaments inappropriés, avec un suivi rigoureux des patients pour assurer la détection d'événements indésirables ou de symptômes de rebond. Une approche combinée centrée sur le patient et le soignant favorise la collaboration entre les prescripteurs et les pharmaciens afin de réduire le nombre de MPI chez les personnes âgées. Reducing potentially inappropriate medications (PIMs) in older adults is an area of sustained interest for many clinicians and researchers across the globe, as PIMs contribute to a significant burden of morbidity and mortality in the aging population. The prevalence of PIMs is a pervasive problem despite the presence of several explicit and implicit criteria for reducing PIMs in older adults, the most common being the Beers criteria, the Screening Tool of Older Persons’ potentially inappropriate Prescriptions/Screening Tool to Alert doctors to the Right Treatment (STOPP/START) criteria, and several country-specific criteria. This narrative review aims to discuss the frequently used published criteria for reducing PIMs, and elucidates the role of certain measures, especially de-prescribing, to optimise medication prescription in older adults. Electronic databases were searched using keywords and MeSH terms. The numerous available criteria have their specific advantages and drawbacks. De-prescribing, an initiative to reduce the use of PIMs, has gained significant importance in improving appropriate prescribing practices. De-prescribing is a methodical approach to gradually stopping inappropriate medications judiciously for each patient and simultaneously monitoring the patient carefully for the onset of adverse events or rebound symptoms. A combined caregiver–patient-centred approach encourages the collaboration between prescribers and pharmacists to reduce PIMs in older adults.
MeSH Terms
- Aged
- Aged, 80 and over
- Deprescriptions
- Humans
- Inappropriate Prescribing
- Medication Reconciliation
- Potentially Inappropriate Medication List
Keywords
- aging
- critères de prescription inappropriés
- de-prescribing
- déprescription
- inappropriate prescribing criteria
- older adults
- personnes âgées
- vieillissement
Geriatric syndromes (GS) do not fit into discrete disease categories and are often underdiagnosed in hospitalized older adults. Geriatric resources (GR) are also not routinely collected in clinical settings, although this may potentiate the beneficial effects of clinical decisions. The prognostic relevance of GS and GR has never been systematically evaluated through clinical tools developed for clinical decision purposes. To ascertain the impact of common GS and GR on patients' prognosis as assessed by means of the comprehensive geriatric assessment (CGA)-based Multidimensional Prognostic Index (MPI). One hundred and thirty-five hospitalized patients aged 70 years and older underwent a CGA evaluation with calculation of the MPI on admission and discharge. Accordingly, patients were subdivided in low (MPI-1, score 0-0.33), moderate (MPI-2, score 0.34-0.66), and severe (MPI-3, score 0.67-1)-risk of mortality at 1 month and 1 year. Nine GR and 17 GS were identified and collected accordingly. A lower number of GS and a higher number of GR were shown to be highly significantly correlated with a lower MPI, as well as years of education, grade of care, and number of medications independent of age, sex and number of GS or GR. Underweight and obesity according to the BMI were significantly correlated to higher number of GS. Patients with more GR had a significantly higher chance of being discharged home. The MPI evaluation together with GS and GR in acute care for older patients should be encouraged to improve clinical decision-making.
MeSH Terms
- Aged
- Aged, 80 and over
- Aging
- Female
- Geriatric Assessment
- Hospitalization
- Humans
- Male
- Multiple Chronic Conditions
- Resilience, Psychological
- Socioeconomic Factors
- Syndrome
Keywords
- Aging medicine
- Comprehensive geriatric assessment (CGA)
- Geriatric resources
- Geriatric syndromes
- Grade of care
- Multidimensional prognostic index (MPI)
The objective of this study was to evaluate factors related to polypharmacy and the use of potentially inappropriate medications (PIM) in elderly patients with diabetes. We studied 127 elderly diagnosed with type 2 diabetes, 41 males (age = 69.9 ± 6.9 years) and 86 women (age = 71.1 ± 7.7 years). For evaluation of health conditions, medication use, polypharmacy and associated factors, we used the questionnaire adapted from Morais. The drugs were classified according to the Anatomical Therapeutic-Chemical Classification System, and for identification of MPI, we adopted the criteria of Beers-Fick and PRISCUS. For data analysis, we used descriptive statistics and chi-square and Fisher Exact tests. In this population, 100% of elderly using drugs. The average consumption was 5.8 per individual drug, varying from two to 14, and the prevalence of polypharmacy was 85%. Among the factors studied, only the retirement showed a statistically significant association (p <0.05) with polypharmacy. The most prevalent diseases were hypertension (92.8%), heart problems (70.8%), circulatory (40.8%) and musculoskeletal problems (44.5%). Of drugs used by the elderly, 12 of them were considered potentially inappropriate and 47.2% of the study subjects make use of these medicines regularly. Thus, this study urges new thinking pharmaceutical assistance, as a practical view in full perspective and not meant only as purchasing and dispensing drugs.
MeSH Terms
- Aged
- Aged, 80 and over
- Aging
- Cross-Sectional Studies
- Diabetes Mellitus, Type 2
- Drug Utilization
- Female
- Humans
- Hypoglycemic Agents
- Male
- Polypharmacy
- Potentially Inappropriate Medication List
Background Previous studies of older drivers have found that there are discrepancies between their retrospective self-reports of collisions and the official jurisdictional record. Objectives The purpose of this study was to examine how older drivers self-report collisions in comparison to what was recorded in their official driver abstract as well as insurance claims, in a prospective study. Methods Participants (n = 125, age ≥ 70 years) in this study were part of the University of Manitoba site of the Candrive longitudinal study of older drivers. During the operation of the Manitoba site (2009 to 2013), participants were periodically asked to report on any collisions (at-fault or not) in which they were involved, while they were enrolled in the study. In addition, driver records (abstracts and insurance claims) from the provincial licensing agency and public insurer (Manitoba Pubic Insurance; MPI) were provided annually. Results In total there were 101 separate instances of collisions (regardless of at-fault status), whether self-reported, or recorded by MPI. There were 20 at-fault collisions that were recorded on the driver abstract. Eighteen of these collisions were self-reported by participants. In total, our participants were involved in 70 insurance claims (42 at-fault) - 61 of these were self-reported to study staff. In addition, there were 31 collisions that were self-reported to study staff, that were not reported to MPI. Conclusions In this prospective study, older drivers were diligent in reporting collisions in which they were involved. While some collisions were not reported that ultimately became a claim or part of their driver abstract, the biggest discrepancy was in the collisions that were reported to study staff but that were not reported to authorities.
MeSH Terms
- Accidents, Traffic
- Aged
- Aged, 80 and over
- Automobile Driving
- Databases, Factual
- Female
- Humans
- Insurance Claim Reporting
- Longitudinal Studies
- Male
- Manitoba
- Prospective Studies
- Self Report
Keywords
- Aging
- Automobile driving
- Motor vehicle collisions
- Road safety
Whether the effect of a low-protein diet on progression to end-stage renal disease (ESRD) and mortality risk differs between young and elderly adults with chronic kidney disease (CKD) is unclear. We conducted a retrospective CKD cohort study to investigate the association between protein intake and mortality or renal outcomes and whether age affects this association. The cohort comprised 352 patients with stage G3-5 CKD who had been followed up for a median 4.2 years, had undergone educational hospitalization, and for whom baseline protein intake was estimated from 24-h urine samples. We classified the patients into a very low protein intake (VLPI) group (<0.6 g/kg ideal body weight/day), a low protein intake (LPI) group (0.6⁻0.8 g), and a moderate protein intake (MPI) group (>0.8 g). Compared with the LPI group, the MPI group had a significantly lower risk of all-cause mortality (hazard ratio: 0.29; 95% confidence interval: 0.07 to 0.94) but a similar risk of ESRD, although relatively high protein intake was related to a faster decline in the estimated glomerular filtration rate. When examined per age group, these results were observed only among the elderly patients, suggesting that the association between baseline dietary protein intake and all-cause mortality in patients with CKD is age-dependent.
MeSH Terms
- Aged
- Aged, 80 and over
- Aging
- Cohort Studies
- Diet, Protein-Restricted
- Dietary Proteins
- Humans
- Middle Aged
- Renal Insufficiency, Chronic
- Retrospective Studies
- Risk Factors
Keywords
- age
- chronic kidney disease
- end-stage renal disease
- mortality
- protein intake
The multidimensional prognostic index (MPI) is a validated, sensitive, and specific prognosis estimation tool based on a comprehensive geriatric assessment (CGA). The MPI accurately predicts mortality after 1 month and 1 year in older, multimorbid patients with acute disease or relapse of chronic conditions. To evaluate whether the MPI predicts indicators of healthcare resources, i.e. grade of care (GC), length of hospital stay (LHS) and destination after hospital discharge in older patients in an acute medical setting. In this study 135 hospitalized patients aged 70 years and older underwent a CGA evaluation to calculate the MPI on admission and discharge. Accordingly, patients were subdivided in low (MPI‑1, score 0-0.33), moderate (MPI-2, score 0.34-0.66) and high (MPI-3, score 0.67-1) risk of mortality. The GC, LHS and the discharge allocation were also recorded. The MPI score was significantly related to LHS (p = 0.011) and to GC (p < 0.001). In addition, MPI-3 patients were significantly more often transferred from other hospital settings (p = 0.007) as well as significantly less likely to be discharged home (p = 0.04) than other groups. The CGA-based MPI values are significantly associated with use of indicators of healthcare resources, including GC, LHS and discharge allocation. These findings suggest that the MPI may be useful for resource planning in the care of older multimorbid patients admitted to hospital.
MeSH Terms
- Activities of Daily Living
- Aged
- Female
- Geriatric Assessment
- Hospitalization
- Humans
- Male
- Patient Admission
- Patient Discharge
- Predictive Value of Tests
- Prognosis
- Risk Assessment
- Risk Factors
Keywords
- Aging medicine
- Clinical decision making
- Comprehensive Geriatric Assessment
- Grade of care
- Prognosis
It is not known whether amino acid supplementations may influence health status in hospitalized older acutely ill patients. The aim of this study was to determine whether nutritional supplementation with amino acids (Aminoglutam ) is associated with multidimensional improvement assessed with the Multidimensional Prognostic Index (MPI). In this randomized, double-blind, placebo-controlled pilot clinical trial, 126 patients aged ≥65 years were enrolled from 6 Italian geriatric wards. A multidimensional assessment to calculate the MPI was performed at baseline and after 4 weeks of treatment with nutritional supplementation (96 kcal, 12 g amino acids, 0.18 g fat, 11.6 g carbohydrate, and vitamins B1, B6, and C) or placebo administered twice a day. Logistic regression modeling was applied to determine the effect of treatment on the improvement of MPI (vs no-change/worsening), adjusting for gender, age, and MPI at baseline. Treatment's interactions with age, gender, and MPI at baseline were tested adding the appropriate interaction parameter in the regression models. Of the 126 patients included, 117 patients (93%) completed the study. A significant improvement in the MPI score was detected in the overall population (mean difference post-pretreatment: -0.03, [i]p[/i]=0.001), with no differences between active and placebo arms. Men in the amino acid supplementation group had a significantly higher rate of improvement in MPI (81%) compared to the placebo group (46%) (Fisher's exact test [i]p[/i]=0.03). Adjusting for age, diagnosis, and MPI at baseline, amino acid treatment was shown to be associated with an improvement in MPI in men (OR=4.82, 95% confidence interval [CI]: 0.87-26.7) and not in women (OR=0.70, 95% CI: 0.27-1.81). The interaction effect between active treatment and gender was significant ([i]p[/i]=0.04). A 4-week amino acid supplementation improved the MPI significantly in hospitalized older male patients but not in female patients. Further studies are needed to confirm the gender effect of amino acid supplementation on MPI in older patients.
MeSH Terms
- Acute Disease
- Administration, Oral
- Aged
- Aged, 80 and over
- Amino Acids
- Dietary Supplements
- Double-Blind Method
- Elder Nutritional Physiological Phenomena
- Female
- Health Status Disparities
- Humans
- Male
- Nutrition Assessment
- Pilot Projects
- Prognosis
- Treatment Outcome
Keywords
- Multidimensional Prognostic Index
- aging
- amino acids
- hospitalization
- oral supplementation
Although the association between low free triiodothyronine (FT3) and poor outcome has been extensively reported in literature, the degree of peripheral thyroxin deiodination and its relationship with frailty and survival in hospitalized older patients has not yet been fully established. The aim of the current study was to evaluate the possible correlation between FT3/free thyroxine (FT4) ratio reduction, an indirect marker of thyroxin deiodination impairment, and frailty status and survival in hospitalized older patients. We consecutively enrolled older patients, hospitalized in the geriatrics ward of the University of Pisa. At admission, Multidimensional Geriatric Assessment (MGA) and Multi Prognostic Index (MPI), an indirect measure of frailty, were obtained from all the patients. Causes of hospitalization and prevalence of delirium were recorded. Blood samples for FT3, FT4, and thyrotropin value evaluation were drawn after an overnight fast. A total of 643 patients (83.8 ± 7.4 years, 53% women) were studied. FT3 was inversely and strongly correlated, whereas FT4 was moderately positively correlated with MGA parameters, MPI score (P < 0.001 and P < 0.05, respectively), and survival (P < 0.001 and P = 0.09, respectively). FT3/FT4 ratio reduction was highly associated with worse MGA (P < 0.001) and MPI scores (P < 0.0001), even in patients without low FT3. The inclusion of FT3 in the final model of multivariate Cox regression confirmed the independent role of FT3/FT4 ratio in predicting survival (P = 0.005). Overall, our study documented a strong association between FT3/FT4 ratio reduction, a surrogate marker of peripheral thyroxin deiodination, and frailty. Moreover, FT3/FT4 ratio value emerged as independent marker of survival, even in patients with normal FT3 values.
MeSH Terms
- Aged
- Aged, 80 and over
- Female
- Frailty
- Geriatric Assessment
- Halogenation
- Hospitalization
- Humans
- Italy
- Life Expectancy
- Male
- Thyroid Function Tests
- Thyrotropin
- Thyroxine
- Triiodothyronine
The age-related decline in motor function is associated with changes in intrinsic brain signatures. Here, we investigated the functional connectivity (FC) associated with masticatory performance, a clinical index evaluating general masticatory function. Twenty-six older adults (OA) and 26 younger (YA) healthy adults were recruited and assessed using the masticatory performance index (MPI) and resting-state functional magnetic resonance imaging (rs-fMRI). We analyzed the rs-fMRI FC network related to mastication, which was constructed based on 12 bilateral mastication-related brain regions according to the literature. For the OA and the YA group, we identified the mastication-related hubs, i.e., the nodes for which the degree centrality (DC) was positively correlated with the MPI. For each pair of nodes, we identified the inter-nodal link for which the FC was positively correlated with the MPI. The network analysis revealed that, in the YA group, the FC between the sensorimotor cortex, the thalamus (THA) and the cerebellum was positively correlated with the MPI. Consistently, the cerebellum nodes were defined as the mastication-related hubs. In contrast, in the OA group, we found a sparser connection within the sensorimotor regions and cerebellum and a denser connection across distributed regions, including the FC between the superior parietal lobe (SPL), the anterior insula (aINS) and the dorsal anterior cingulate cortex (dACC). Compared to the YA group, the network of the OA group also comprised more mastication-related hubs, which were spatially distributed outside the sensorimotor regions, including the right SPL, the right aINS, and the bilateral dACC. In general, the findings supported the hypothesis that in OA, higher masticatory performance is associated with a widespread pattern of mastication-related hubs. Such a widespread engagement of multiple brain regions associated with the MPI may reflect an increased demand in sensorimotor integration, attentional control and monitoring for OA to maintain good mastication.
Keywords
- aging
- functional connectivity
- graph theory
- magnetic resonance imaging
- mastication
To investigate the relationship between warfarin treatment and different strata of all-cause mortality risk assessed using the Multidimensional Prognostic Index (MPI) based on information collected using the Standardized Multidimensional Assessment Schedule for Adults and Aged Persons (SVaMA) in community-dwelling older adults with atrial fibrillation (AF). Retrospective observational study. Older community-dwelling adults who underwent a SVaMA evaluation establishing accessibility to homecare services and nursing home admission from 2005 to 2013 in the Padova Health District, Italy. Community-dwelling individuals with AF aged 65 and older (N = 1,827). Participants were classified as being at mild (MPI-SVaMA-1), moderate (MPI-SVaMA-2), or severe (MPI-SVaMA-3) risk of mortality using the MPI-SVaMA, a validated prognostic tool based on age, sex, comorbidity, cognitive status, mobility and functional disability, pressure sore risk, and social support. The association between warfarin treatment and mortality was tested using multivariate- and propensity score-adjusted Cox regression models, controlling for age, sex, all SVaMA domains, concomitant diseases, and drug treatments. Higher MPI-SVaMA scores were associated with lower rates of warfarin treatment and higher 3-year mortality. After adjustment for propensity score quintiles, warfarin treatment was significantly associated with lower 2-year mortality in individuals with MPI-SVaMA-1 (hazard ratio (HR) = 0.64, 95% confidence interval (CI) = 0.50-0.82), MPI-SVaMA-2 (HR = 0.68, 95% CI = 0.55-0.85), and MPI-SVaMA-3 (HR = 0.55, 95% CI = 0.44-0.67). Heterogeneity analyses confirmed that the effect of warfarin treatment was not different between MPI-SVaMA groups (P for heterogeneity = .48). Community-dwelling older adults with AF benefitted from anticoagulation in terms of lower all-cause mortality over a mean follow-up of 2 years, regardless of poor health and functional condition. Although this benefit can be ascribed to the treatment, it may also reflect better overall care.
MeSH Terms
- Aged
- Aged, 80 and over
- Anticoagulants
- Atrial Fibrillation
- Cause of Death
- Female
- Geriatric Assessment
- Humans
- Independent Living
- Italy
- Male
- Prognosis
- Propensity Score
- Retrospective Studies
- Risk Assessment
- Risk Factors
- Warfarin
Keywords
- aging
- all-cause mortality
- atrial fibrillation
- frailty
- multidimensional prognostic index
- warfarin
We investigated and describe change in the Multidimensional Prognostic Index (MPI) score between admission and discharge in 960 older patients admitted to 20 geriatric units for an acute disease or a relapse of a chronic disease. The MPI was calculated at admission and at discharge. Subjects were divided into three groups of MPI score, low risk (MPI-1 value ≤0.33), moderate risk (MPI-2 value 0.34-0.66), and severe risk of mortality (MPI-3 value ≥0.67), on the basis of previously established cutoffs. Variation of MPI values over length of hospital stay (LOS) was analyzed with a multivariable longitudinal linear model for repeated measurements. At admission, 23.5% subjects had an MPI-1 score, 33.3% had an MPI-2 score, and 43.0% had an MPI-3 score. Overall, for almost 60% of the patients, MPI score at hospital discharge was different compared with the score at admission, although the difference was not statistically significant (-0.003; p = 0.708). Patients with high and intermediate MPI scores at admission had a decrease of MPI score at discharge (delta-MPI -0.026, p < 0.001, and delta-MPI -0.066, p = 0.569, respectively), whereas patients in the MPI-low group, experienced a significant increase in MPI score (delta-MPI 0.041, p < 0.001). The evolution of MPI score as a function of LOS had a curvilinear shape because it significantly decreased for patients with short hospitalization (1-6 days) and tended to increase for those with longer LOS. The MPI, a well-established prognostic tool, is sensitive to change of patient's health status and might be used to objectively track and monitor the clinical evolution of acutely ill geriatric patients admitted to the hospital.
MeSH Terms
- Activities of Daily Living
- Acute Disease
- Age Factors
- Aged
- Aged, 80 and over
- Aging
- Chi-Square Distribution
- Chronic Disease
- Cognition
- Comorbidity
- Female
- Geriatric Assessment
- Hospitalization
- Humans
- Italy
- Length of Stay
- Linear Models
- Male
- Multivariate Analysis
- Nutrition Assessment
- Nutritional Status
- Patient Admission
- Patient Discharge
- Polypharmacy
- Predictive Value of Tests
- Prognosis
- Psychiatric Status Rating Scales
- Recurrence
- Risk Assessment
- Risk Factors
- Time Factors
To investigate the value of different quantitative models of diffusion-weighted multiparametric imaging (DW-MPI) including traditional as well as several advanced models for monitoring the longitudinal parameter changes in rabbit liver VX2 carcinoma and for correlating the perfusion-related imaging parameters to vascularity of tumor tissue. Rabbit liver VX2 carcinoma was imaged by DW-MPI at the 2nd, 3rd, and 4th weeks after tumor implantation at 1.5T using two sets of b values ranging from 0 to 2000 s/mm(2) . Serial parameter changes of each model at three timepoints were compared. Univariate and multivariate regression analyses were carried out to analyze the ability of perfusion-related parameters, including apparent diffusion coefficient (ADC), perfusion fraction (f), and pseudodiffusion coefficient (D*), to predict mean microvessel density (MVD) as determined by quantitative histopathology. For the period from Week 2 to Week 4, the measurements of ADC, f, and KDKI illustrated a statistical difference (P = 0.000, P = 0.000, and P = 0.002, respectively), whereas the comparison of D, D*, DDKI , DSEM , and αSEM demonstrated no statistical significance. ADC and f showed highest correlation with MVD at Week 4 (r(2) = 0.307, P = 0.017, and r(2) = 0.402, P < 0.01, respectively). Multivariate analyses confirmed highest correlation of f and ADC with MVD at Week 4 (P = 0.001 and P = 0.002). ADC, f, and KDKI were identified as the most promising parameters for monitoring changes in rabbit liver VX2 carcinoma and f and ADC showed highest correlation with MVD. J. Magn. Reson. Imaging 2016;44:707-714.
MeSH Terms
- Aging
- Animals
- Cell Line, Tumor
- Diffusion Magnetic Resonance Imaging
- Female
- Humans
- Image Enhancement
- Image Interpretation, Computer-Assisted
- Liver Neoplasms
- Longitudinal Studies
- Male
- Multimodal Imaging
- Rabbits
- Reproducibility of Results
- Sensitivity and Specificity
- Subtraction Technique
Keywords
- apparent diffusion coefficient
- diffusion-weighted MRI
- liver carcinoma
The challenge of immune senescence has never been addressed in elderly cancer patients. This study compares the thymic output and peripheral blood telomere length in ≥70year old cancer patients. Fifty-two elderly cancer patients and 39 age-matched controls without personal history of cancer were enrolled. All patients underwent a Comprehensive Geriatric Assessment (CGA), from which a multidimensional prognostic index (MPI) score was calculated. Peripheral blood samples were studied for naïve and recent thymic emigrant (RTE) CD4( ) and CD8( ) cells by flow cytometry. T-cell receptor rearrangement excision circle (TREC) levels, telomere length and telomerase activity in peripheral blood cells were quantified by real-time PCR. The percentages of CD8( ) naïve and CD8( ) RTE cells and TREC levels were significantly lower in cancer patients than in controls (p=0.003, p=0.004, p=0.031, respectively). Telomere lengths in peripheral blood cells were significantly shorter in cancer patients than in controls (p=0.046) and did not correlate with age in patients, whereas it did in controls (r=-0.354, p=0.031). Short telomere (≤median)/low TREC (≤median) profile was associated with higher risk of cancer (OR=3.68 [95% CI 1.22-11.11]; p=0.021). Neither unfitness on CGA nor MPI score were significantly related to thymic output or telomere length in either group. Immune senescence is significantly worse in elderly cancer patients than in age-matched controls. The low thymic output and the shorter telomeres in peripheral blood cells of cancer patients may reflect a pre-existing condition which facilitates the onset of malignancies in elderly people.
MeSH Terms
- Age Factors
- Aged
- Aged, 80 and over
- Aging
- Biomarkers
- Breast Neoplasms
- CD4-Positive T-Lymphocytes
- CD8-Positive T-Lymphocytes
- Case-Control Studies
- Chi-Square Distribution
- Colorectal Neoplasms
- Female
- Flow Cytometry
- Gene Rearrangement, T-Lymphocyte
- Geriatric Assessment
- Humans
- Logistic Models
- Male
- Odds Ratio
- Polymerase Chain Reaction
- Prospective Studies
- Risk Factors
- Telomerase
- Telomere Shortening
- Thymus Gland
Keywords
- ADL
- Activities of Daily Living
- CGA
- CIRS-CI
- CIRS-SI
- CMV
- Cancer
- Cumulative Illness Rating Scale-Comorbidity Index
- Cumulative Illness Rating Scale-Severity Index
- Cytomegalovirus
- Elderly
- GDS
- Geriatric Depression Scale
- IADL
- Immune senescence
- Instrumental Activities of Daily Living
- MMSE
- MNA
- MPI
- Mini Mental Status Examination
- Mini Nutritional Assessment
- PBMC
- RTE
- RU
- SPMSQ
- Short Portable Mental Status Questionnaire
- T-cell receptor rearrangement excision circle
- T/S
- TREC
- Telomerase activity
- Telomere length
- Thymic output
- comprehensive geriatric assessment
- multidimensional prognostic index
- peripheral blood mononuclear cells
- recent thymic emigrant
- relative units
- telomere/single-copy gene
A combination of several metabolic and hormonal adaptations has been proposed to control aging. Little is known regarding the effects of multiple deregulations of these metabolic and hormonal systems in modulating frailty and mortality in hospitalized elderly patients. We measured 17 biological serum parameters from different metabolic/hormonal pathways in 594 hospitalized elderly patients followed up to 1 year who were stratified into three groups according to their multidimensional impairment, evaluated by a Comprehensive Geriatric Assessment (CGA)-based Multidimensional Prognostic Index (MPI). The mortality incidence rates were 7% at 1 month and 21% at 1 year. Our data show that frailty and mortality rate were positively associated with chronic inflammation and with a down-regulation of multiple endocrine factors. Of the 17 biomarkers examined, blood levels of IGF-1, triiodothyronine, C-reactive protein, erythrocyte sedimentation rate, white blood cell and lymphocyte counts, iron, albumin, total cholesterol, and LDL-c were significantly associated with both MPI severity grade and mortality. In multivariate Cox proportional hazard model, the following biomarkers most strongly predicted the risk of mortality (adjusted hazard ratio (HR) per 1 quintile increment in predictor distribution): IGF-1 HR = 0.71 (95% CI: 0.63-0.80), CRP HR = 1.48 (95% CI: 1.32-1.65), hemoglobin HR = 0.82 (95% CI: 0.73-0.92), and glucose HR = 1.17 (95% CI: 1.04-1.30). Multidimensional impairment assessed by MPI is associated with a distinctive metabolic 'signature'. The concomitant elevation of markers of inflammation, associated with a simultaneous reduction in multiple metabolic and hormonal factors, predicts mortality in hospitalized elderly patients.
MeSH Terms
- Aged
- Aged, 80 and over
- Aging
- Biomarkers
- Blood Sedimentation
- C-Reactive Protein
- Cholesterol, LDL
- Female
- Frail Elderly
- Hormones
- Hospitalization
- Humans
- Inflammation
- Insulin-Like Growth Factor I
- Iron
- Leukocyte Count
- Lymphocyte Count
- Male
- Mortality
- Proportional Hazards Models
- Serum Albumin
- Triiodothyronine