Characteristics associated with falls among the elderly within aged care wards in a tertiary hospital： a retrospective case-control study

Background Falls are the most frequently reported adverse events in inpatient settings. We conducted a retrospective case-control study of inpatient falls within aged care wards in a tertiary hospital to investigate the associated characteristics of elderly patients suffering from falls and fall-related characteristics. Methods Consecutive retrospective cross-sectional design spanned July 2006 to December 2008. Patient group： Information on all aged care inpatients who suffered from 1 or more falls was extracted from Incident Information Management System （IIMS）. Further details about the particular admission（s） were obtained from patients＇ medical records, e.g., patients＇ characteristics and circumstances surrounding the falls. Randomly selected aged care patients who did not suffer from a fall and who were discharged from the hospital in the same period served control group. Characteristics among patients with single fall and recurrent falls, as well as non-railers were compared. Results Of the 438 falls evaluated, 71.9% occurred in patients＇ room and 18.9% in patients＇ bathroom/toilet. The common activities were moving/transferring and taking shower/toileting, respectively, 70.3%, 12.1% while occurring falls; and time of falls had a high peak during 9：00-11：00 a.m. Many were unassisted while falling. The common contributing factors for fall were intrinsic factors. Patients with recurrent falls were more likely to have lower Mini-Mental State Examination （MMSE） score. Logistic regression analysis showed length of stay longer than five weeks, dementia and stroke were independent risk factors for recurrent falls; and living in hostel/nursing home preadmission, needing assistance with mobility, cognitive impairment, stroke, incontinence and arthritis/osteoporosis were independent risk factors for fall. Conclusions In an aged care ward, falls are independently associated with recurrent factors. Cognitive impairment/dementia was a strong risk factor for falls, and main causes leading to fall were intrinsic factors. For patients with cognitive impairment/dementia and behavioral disorder providing special and effective interventions is of paramount importance for reducing the incidence of fall in an aged care ward in hospital settings.

Strategies for translating proteomics discoveries into drug discovery for dementia

Tauopathies,diseases characterized by neuropathological aggregates of tau including Alzheimer's disease and subtypes of fro ntotemporal dementia,make up the vast majority of dementia cases.Although there have been recent developments in tauopathy biomarkers and disease-modifying treatments,ongoing progress is required to ensure these are effective,economical,and accessible for the globally ageing population.As such,continued identification of new potential drug targets and biomarkers is critical."Big data"studies,such as proteomics,can generate information on thousands of possible new targets for dementia diagnostics and therapeutics,but currently remain underutilized due to the lack of a clear process by which targets are selected for future drug development.In this review,we discuss current tauopathy biomarkers and therapeutics,and highlight areas in need of improvement,particularly when addressing the needs of frail,comorbid and cognitively impaired populations.We highlight biomarkers which have been developed from proteomic data,and outline possible future directions in this field.We propose new criteria by which potential targets in proteomics studies can be objectively ranked as favorable for drug development,and demonstrate its application to our group's recent tau interactome dataset as an example.

Diabetic muscle infarction in end-stage renal disease: A scoping review on epidemiology, diagnosis and treatment

Diabetic muscle infarction(DMI) refers to spontaneous ischemic necrosis of skeletal muscle among people with diabetes mellitus, unrelated to arterial occlusion. People with DMI may have coexisting end-stage renal disease(ESRD) but little is known about its epidemiology and clinical outcomes in this setting. This scoping review seeks to investigate the characteristics, clinical features, diagnostic evaluation, management and outcomes of DMI among people with ESRD. Electronic database (Pub Med/MEDLINE, CINAHL, SCOPUS and and EMBASE) searches were conducted for ("diabetic muscle infarction" or "diabetic myonecrosis") and("chronic kidney disease" or "renal impairment" or "dialysis" or "renal replacement therapy" or "kidney transplant ") from January 1980 to June 2017. Relevant cases from reviewed bibliographies in reports retrieved were also included. Data were extracted in a standardized form. A total of 24 publications with 41 patients who have ESRD were included. The mean age at the time of presentation with DMI was 44.2 years. Type 2 diabetes was present in 53.7% of patients while type 1 in 41.5%. In this cohort, 60.1% were receiving hemodialysis, 21% on peritoneal dialysis and 12.2% had kidney transplantation. The proximal lower limb musculature was the most commonly affected site. Muscle pain and swelling were the most frequent manifestation on presentation. Magnetic resonance imaging (MRI) provided the most specific findings for DMI. Laboratory investigation findings are usually non-specific. Non-surgical therapy is usually used in the management of DMI. Short-term prognosis of DMI is good but recurrence occurred in 43.9%. DMI is an uncommon complication in patients with diabetes mellitus, including those affected by ESRD. In comparison with unselected patients with DMI, the characteristics and outcomes of those with ESRD are generally similar. DMI may also occur inkidney transplant recipients, including pancreas-kidney transplantation. MRI is the most useful diagnostic investigation. Non-surgical treatment involving analgesia, optimization of glycemic control and initial bed rest can help to improve recovery rate. However, recurrence of DMI is relatively frequent.

Neutrophil-lymphocyte ratio in the management and prediction of outcomes in renal cell carcinoma

Renal cell carcinoma(RCC) is one of the ten most common malignancies.The prognosis of RCC is poor when the disease is in advanced stages,with five-year survival of less than 10%.However current assessment approaches are limited in their ability to prognosticate and guide therapeutic decision-making.Cellular-mediated inflammatory response is increasingly being recognised to have an important role in carcinogenesis of RCC.Various inflammatory markers have been found to identify patients with RCC at high risk of recurrence and predict survival.Neutrophil-lymphocyte ratio(NLR) is a simple and inexpensive inflammatory marker that has been shown to be of value in the assessment of patients with RCC.An elevated pretreatment NLR has been found to be associated with reduced overall survival,recurrence-free survival and progress-free survival and risk of recurrence in localized RCC.In addition,lower pretreatment NLR has been demonstrated to be associated with better clinical response to systemic therapy including vascular endothelial growth factor inhibitors,among patients with metastatic RCC.However,NLR has not been found to differentiate whether small renal masses of less than 40 mm are benign or malignant.Further research is needed to determine the cut-offs for NLR to predict different clinical outcomes and how post-treatment NLR can be used.In addition,more work is also needed to evaluate combining NLR with other biomarkers in a model to predict patients' clinical outcome or response to treatment for RCC.

Gender differences in challenging behaviors,management and outcomes in elderly patients with delirium

BACKGROUND： Gender differences have been reported in some common mental disorders. However, few studies have monitored gender differences in individuals with delirium. OBJECTIVE： To explore gender differences in challenging behaviors, management and outcomes in age-matched elderly patients with delirium.DESIGN, TIME AND SETTING： A retrospective cohort study was performed in the Bankstown-Lidcombe Hospital, Sydney, Australia, from October 2008 to April 2009. METHODS： Patients, aged 65-90 years, diagnosed with delirium according to the International Classification of Diseases （ICD）-10 in the Psychogeriatric Unit of Bankstown Lidcombe Hospital from January 2002 to October 2008 were reviewed. All the patients were measured according to the Confusion Assessment Method upon admission. Those who developed delirium during hospitalization were excluded.MAIN OUTCOME MEASURES： Cause of delirium, wandering, aggression, duration of delirium, physical restraint, use of antipsychotic medicine, recovery from delirium, discharge back home, length of stay, one-to-one nursing care, falls and absconding rate.RESULTS： The 131 age-matched delirious patients comprised 54 males and 77 females. The behavioral disorders of wandering [odds ration （OR） = 2.612, 95% confidence interval （CI） = 1.26 -5.413, P = 0.009] and aggression （OR = 2.243, 95% CI = 1.028 - 4.891, P= 0.04） were more frequent in males than in females. More males received one-to-one nursing care （OR = 4.114, 95% CI = 1.355 - 12.491, P = 0.008）, were more likely to receive antipsychotic medications （OR = 2.24, 95% CI = 1.095-4.583, P = 0.021） and more likely to be physically restrained （OR = 2.07, 95% CI = 1.02-1.02, P = 0.043） compared with female patients. All absconding patients （3/131, 2.3%） were male. In addition, male patients displayed a greater falling rate compared with females （OR = 4.57, 95% CI= 1.519-13.722, P = 0.004）.CONCLUSION： There are gender differences in challenging behaviors, management and outcomes in elderly delirious patients. Males with delirium display more challenging behaviors that require physical restraint and pharmacological management including wandering and aggression; males also abscond and have a higher rate of falls compared with female patients.

Chronic kidney disease after radical nephrectomy for suspected renal cancers

Nephrectomy is the treatment of choice for early stage renal cell carcinoma. However,radical nephrectomy is consistently associated with higher rates of newonset chronic kidney disease(CKD) than the general population,regardless of the method used in measuring renal function. The higher rates of CKD are associated with worsened survival because of increased risk of cardiovascular diseases and mortality. Comorbidities and adjacent non-neoplastic kidney diseases are important risk factors for the development of CKD after nephrectomy. Partial nephrectomy has become the standard of care for patients with stage 1a tumours(diameter < 4 cm) and an attractive option for those with stage 1b(diameter 4-7 cm). Therefore stratifying the risk of postoperative CKD before surgery is important and ongoing monitoring of kidney function after radical nephrectomy is needed in addition to oncological surveillance. More research is needed to better understand the risk of CKD after radical nephrectomy and develop effective strategies to optimize kidney function after such surgery.

Uptake and mitochondrial dysfunction of alpha-synuclein in human astrocytes, cortical neurons and fibroblasts

The accumulation and aggregation of alpha-synuclein(α-syn)in several tissue including the brain is a major pathological hallmark in Parkinson’s disease(PD).In this study,we show that α-syn can be taken up by primary human cortical neurons,astrocytes and skin-derived fibroblasts in vitro.Our findings that brain and peripheral cells exposed to α-syn can lead to impaired mitochondrial function,leading to cellular degeneration and cell death,provides additional evidence for the involvement of mitochondrial dysfunction as a mechanism of toxicity of α-syn in human cells.

Mortality Trend and Predictors of Mortality in Dysphagic Stroke Patients Postpercutaneous Endoscopic Gastrostomy

Background：Percutaneous endoscopic gastrostomy （PEG） feeding is widely used in stroke patients suffering from persistent dysphagia;however,predicting the risks and benefits of PEG insertion in the individual patient is difficult.The aim of our study was to investigate if candidate risk factors could predict short-term mortality risk in poststroke patients who had PEG tube insertion for persistent dysphagia.Methods：This was a retrospective study of 3504 consecutive stroke patients admitted to two metropolitan hospitals during the period January 2005 to December 2013 and who also underwent PEG insertion for feeding due to persistent dysphagia.Results：A total of 102 patients were included in the study.There were 22 deaths in 6 months after insertion of PEG tubes and 20 deaths of those occurred within 3 months post PEG.Those who survived beyond 6 months showed significantly lower mean age （75.9 ± 9.0 years vs.83.0 ± 4.9 years,P 〈 0.001）,a lower mean American Society of Anesthesia （ASA） score （3.04 ± 0.63 vs.3.64 ± 0.58,P 〈 0.001） compared to nonsurvivors.In multiple Logistic,age （P =0.004,odds ratio [OR] =1.144;95% confidence interval [CI]：1.044-1.255）;ASA （P =0.002,OR =5.065;95% CI：1.815-14.133） and albumin level pre-PEG insertion （P =0.033,OR =0.869;95% CI：0.764-0.988）were the independent determinants of mortality respectively.Conclusions：We propose that age,ASA score and albumin level pre-PEG insertion to be included as factors to assist in the selection of patients who are likely to survive more than 3 months post PEG insertion.

Mini-review on initiatives to interfere with the propagation and clearance of alphasynuclein in Parkinson’s disease

In this mini-review,we summarize recent findings relating to the prion-like propagation ofα-synuclein(α-syn)and the development of novel therapeutic strategies to target synucleinopathy in Parkinson’s disease(PD).We link the Braak’s staging hypothesis of PD with the recent evidence from in-vivo and in-vitro studies for the prion-like cell-to-cell propagation ofα-syn(via exocytosis and endocytosis).The classical accumulation of aggregatedα-syn in PD may result from an increased production or a failure in the mechanisms of clearance ofα-syn.We discuss novel agents,currently in clinical trial for PD including the ones that impact the aggregation ofα-syn and others that interfere withα-syn endocytosis as a means to target the progression of the disease.

Biomarker-based diagnosis of cognitive disorders in a case series

The classical cerebrospinal fluid biomarkers of Alzheimer's Disease (namely total tau, phospho-tau and amyloid beta peptide) have received much attention, since they can detect the biochemical fingerprint of Alzheimer's disease and serve as a diagnostic aid for correct diagnosis of cognitive disorders during life. In this case series, we present 6 examples of patients with cognitive impairment of various types and severities and how biomarker data were helpful in every day diagnostic approach, combined with clinical, neuropsychological and imaging data and based on the most recent guidelines and recommendations.