DISORDERS OF THE DIGESTIVE-SYSTEM IN THE ELDERLY

CHANGES in the anatomy and physiology of the epithelium of the digestive organs because of aging are slight.1 The functional capacity of both the secretory and absorptive cells of the gut is so great that a decrease to as little as 5 to 10 percent of normal function is required for a clinical effect to be evident. In contrast to the epithelial-cell reserve, connective-tissue changes are manifested in midlife, and age-related changes in these tissues are responsible for many digestive disorders, such as colonic vascular ectasias and diverticula of the gut. The anatomical and physiologic changes that do occur in the elderly may be due to the vicissitudes of life (intercurrent disease or the effects of the environment, nutrition, alcohol, tobacco, or other drugs) or to specific disease rather than to aging alone. The decreased effectiveness of the immune system in the elderly2 may influence the course of diseases of the gastrointestinal tract. The number of antibodies to foreign antigens decreases with aging, whereas the number of autoantibodies increases.3 Alterations in T-cell function occur more frequently than changes in B-cell function in the elderly.3 Little is known about how such immunologic changes affect the course of specific diseases of the digestive system. The polypharmacy that is common among the elderly4 complicates the evaluation and treatment of digestive disorders in these patients. The indiscriminate and inappropriate use of medications to treat gastrointestinal disorders should be avoided in order to prevent some of the adverse reactions, such as delirium from cimetidine, constipation from iron supplements and aluminum-containing antacids, and diarrhea from magnesium-containing antacids and prostaglandin analogues.4 , 5 This review will consider some of the age-related changes of the digestive organs and some of the diseases to which the elderly are particularly vulnerable. Neoplasms will not be discussed

A Systematic Review and Aggregated Analysis on the Impact of Amyloid PET Brain Imaging on the Diagnosis, Diagnostic Confidence, and Management of Patients being Evaluated for Alzheimer's Disease.

BACKGROUND: Amyloid PET (aPET) imaging could improve patient outcomes in clinical practice, but the extent of impact needs quantification. OBJECTIVE: To provide an aggregated quantitative analysis of the value added by aPET in cognitively impaired subjects. METHODS: Systematic literature searches were performed in Embase and Medline until January 2017. 1,531 cases over 12 studies were included (1,142 cases over seven studies in the primary analysis where aPET was the key biomarker; the remaining cases included as defined groups in the secondary analysis). Data was abstracted by consensus among two observers and assessed for bias. Clinical utility was measured by diagnostic change, diagnostic confidence, and patient management before and after aPET. Three groups were further analyzed: control patients for whom feedback of aPET scan results was delayed; aPET Appropriate Use Criteria (AUC+) cases; and patients undergoing additional FDG/CSF testing. RESULTS: For 1,142 cases with only aPET, 31.3% of diagnoses were revised, whereas 3.2% of diagnoses changed in the delayed aPET control group (p < 0.0001). Increased diagnostic confidence following aPET was found for 62.1% of 870 patients. Management changes with aPET were found in 72.2% of 740 cases and in 55.5% of 299 cases in the control group (p < 0.0001). The diagnostic value of aPET in AUC+ patients or when FDG/CSF were additionally available did not substantially differ from the value of aPET alone in the wider population. CONCLUSIONS: Amyloid PET contributed to diagnostic revision in almost a third of cases and demonstrated value in increasing diagnostic confidence and refining management plans

Intra-accumbens injections of the adenosine A(2A) agonist CGS 21680 affect effort-related choice behavior in rats

Rationale: Nucleus accumbens dopamine (DA) participates in the modulation of instrumental behavior, including aspects of behavioral activation and effort-related choice behavior. Rats with impaired accumbens DA transmission reallocate their behavior away from food-reinforced activities that have high response requirements, and instead select less-effortful types of food-seeking behavior. Although accumbens DA is considered a critical component of the brain circuitry regulating effort-related processes, emerging evidence also implicates adenosine A2A receptors. Objective: The present work was undertaken to test the hypothesis that accumbens A2A receptor stimulation would produce effects similar to those produced by DA depletion or antagonism. Methods: Three experiments assessed the effects of the adenosine A2A agonist CGS 21680 on performance of a concurrent choice task (lever pressing for preferred food vs. intake of less preferred chow) that is known to be sensitive to DA antagonists and accumbens DA depletions. Results: Systemic injections of CGS 21680 reduced lever pressing but did not increase feeding. In contrast, bilateral infusions of the adenosine A2A receptor agonist CGS 21680 (6.0- 24.0 ng) into the nucleus accumbens decreased lever pressing for the preferred food, but substantially increased consumption of the less preferred chow. Injections of CGS 21680 into a control site dorsal to the accumbens were ineffective. Conclusions: Taken together, these results are consistent with the hypothesis that local stimulation of adenosine A2A receptors in nucleus accumbens produces behavioral effects similar to those induced by accumbens DA depletions. Accumbens adenosine A2A receptors appear to be a component of the brain circuitry regulating effort-related choice behavio

Astroparticle Aspects of Supersymmetry

After recalling the motivations for expecting supersymmetry to appear at energies below 1 TeV, the reasons why the lightest supersymmetric particle is an ideal candidate for cold dark matter are reviewed from a historical perspective. Recent calculations of the relic density including coannihilations and rapid annihilations through direct-channel Higgs boson poles are presented. The experimental constraints from LEP and elsewhere on supersymmetric dark matter are reviewed, and the prospects for its indirect or direct detection are mentioned. The potential implications of a Higgs boson weighing about 115 GeV and the recent measurement of the anomalous magnetic moment of the muon are summarized.Comment: 12 pages, 10 eps figures, invited plenary talk at conference on 30 Years Of Supersymmetry, Oct. 2000, Minneapolis, Minnesot

Improved Results in Supersymmetric Electroweak Baryogenesis

Electroweak baryogenesis provides a very attractive scenario to explain the origin of the baryon asymmetry. The mechanism of electroweak baryogenesis makes use of the baryon number anomaly and relies on physics that can be tested experimentally. It is today understood that, if the Higgs mass is not larger than 120 GeV, this mechanism may be effective within supersymmetric extensions of the Standard Model. In this work, we reconsider the question of baryon number generation at the electroweak phase transition within the context of the minimal supersymmetric extension of the Standard Model. We derive the relevant diffusion equations, give a consistent definition of the sources, and compare our results with those appearing in the recent literature on this subjectComment: 19 pages, 2 figure

Supersymmetry Without Prejudice at the LHC

The discovery and exploration of Supersymmetry in a model-independent fashion will be a daunting task due to the large number of soft-breaking parameters in the MSSM. In this paper, we explore the capability of the ATLAS detector at the LHC ($\sqrt s=14$ TeV, 1 fb$^{-1}$) to find SUSY within the 19-dimensional pMSSM subspace of the MSSM using their standard transverse missing energy and long-lived particle searches that were essentially designed for mSUGRA. To this end, we employ a set of $\sim 71$k previously generated model points in the 19-dimensional parameter space that satisfy all of the existing experimental and theoretical constraints. Employing ATLAS-generated SM backgrounds and following their approach in each of 11 missing energy analyses as closely as possible, we explore all of these $71$k model points for a possible SUSY signal. To test our analysis procedure, we first verify that we faithfully reproduce the published ATLAS results for the signal distributions for their benchmark mSUGRA model points. We then show that, requiring all sparticle masses to lie below 1(3) TeV, almost all(two-thirds) of the pMSSM model points are discovered with a significance $S>5$ in at least one of these 11 analyses assuming a 50\% systematic error on the SM background. If this systematic error can be reduced to only 20\% then this parameter space coverage is increased. These results are indicative that the ATLAS SUSY search strategy is robust under a broad class of Supersymmetric models. We then explore in detail the properties of the kinematically accessible model points which remain unobservable by these search analyses in order to ascertain problematic cases which may arise in general SUSY searches.Comment: 69 pages, 40 figures, Discussion adde

Exclusive Hadronic Processes and Color Transparency

We review the current status of high energy exclusive processes and color transparency.Comment: 17 pages, 8 figures, based on talk given at International Symposium on Nuclear Physics, Mumbai, Dec 18-22, 200

Nuclear and nucleon transitions of the H di-baryon

We consider 3 types of processes pertinent to the phenomenology of an H di-baryon: conversion of two $\Lambda$'s in a doubly-strange hypernucleus to an H, decay of the H to two baryons, and -- if the H is light enough -- conversion of two nucleons in a nucleus to an H. We compute the spatial wavefunction overlap using the Isgur-Karl and Bethe-Goldstone wavefunctions, and treat the weak interactions phenomenologically. The observation of $\Lambda$ decays from doubly-strange hypernuclei puts a constraint on the H wavefunction which is plausibly satisfied. In this case the H is very long-lived as we calculate. An absolutely stable H is not excluded at present. SuperK can provide valuable limits

Accelerating the Drug Delivery Pipeline for Acute and Chronic Pancreatitis: Summary of the Working Group on Drug Development and Trials in Chronic Pancreatitis at the National Institute of Diabetes and Digestive and Kidney Diseases Workshop

The lack of effective therapeutic agents specifically tailored for chronic pancreatitis (CP) has hampered clinical care and negatively impacted patients' lives. New mechanistic insights now point to novel therapies, which involve both recently developed and/or repurposed agents. This working group focused on 2 main outcomes for CP: pain and progression of disease. The goal is to frame the essential aspects of trial design including patient-centered outcomes, proposed methods to measure the outcomes of pain and progression, and study design considerations for future trials to facilitate rapid drug development for patients with CP