Use of Oral Anticoagulant for Secondary Prevention of Stroke in Very Elderly Patients With Atrial Fibrillation: An Observational Study

SummaryBackgroundOral anticoagulant (OAC) is proven to be more effective than antiplatelet therapy in the secondary prevention of ischemic stroke in patients with atrial fibrillation (AF). The objective of this study was to determine the effect of age on the prescription of OAC and its actual use by neurologists for secondary prevention among the very elderly patients with AF hospitalized for ischemic stroke.MethodsIn this prospective observational study, data from patients with first-ever ischemic stroke and AF were included. We reviewed the use of antithrombotic agents before stroke onset and at discharge in patients with AF who were aged 80 years or older. We analyzed the trends of oral anticoagulation as secondary prevention in very elderly patients and identify the reasons why anticoagulant was not prescribed at discharge.ResultsA total of 152 patients with AF experienced first-ever ischemic stroke. Of these, 51 patients (33.6%) were ≥80 years of age, and 101 were <80 years of age. Thirteen patients died during the acute stroke and thus were excluded from the analysis. Of 139 ischemic stroke survivors at discharge, 45 were ≥80 years of age and 94 were <80 years of age. For those aged ≥80 years, 62.2% received neither antiplatelet nor anticoagulant agents before stroke onset. Surprisingly, only one patient (2.2%) was treated with OAC. At discharge, only 12 patients (26.7%) aged ≥80 years were treated with OAC compared with those aged <80 years (48/94 [51.1%]).ConclusionThis study suggests that OAC is underused in most of the very elderly patients despite its proven efficacy. A history of stroke did alter the trend of use of antithrombotic agents in this age group

The Non-linear Relationship between Muscle Voluntary Activation Level and Voluntary Force Measured by the Interpolated Twitch Technique

Interpolated twitch technique (ITT) is a non-invasive method for assessing the completeness of muscle activation in clinical settings. Voluntary activation level (VA), measured by ITT and estimated by a conventional linear model, was reported to have a non-linear relationship with true voluntary contraction force at higher activation levels. The relationship needs to be further clarified for the correct use by clinicians and researchers. This study was to established a modified voluntary activation (modified VA) and define a valid range by fitting a non-linear logistic growth model. Eight healthy male adults participated in this study. Each subject performed three sets of voluntary isometric ankle plantar flexions at 20, 40, 60, 80 and 100% maximal voluntary contraction (MVC) with real-time feedback on a computer screen. A supramaximal electrical stimulation was applied on tibia nerve at rest and during contractions. The estimated VA was calculated for each contraction. The relationship between the estimated VA and the actual voluntary contraction force was fitted by a logistic growth model. The result showed that according to the upper and lower limit points of the logistic curve, the valid range was between the 95.16% and 10.55% MVC. The modified VA estimated by this logistic growth model demonstrated less error than the conventional model. This study provided a transfer function for the voluntary activation level and defined the valid range which would provide useful information in clinical applications

Carbon monoxide may enhance bile secretion by increasing glutathione excretion and Mrp2 expression in rats

AbstractBackgroundNitric oxide (NO) donors have been reported to induce choleresis via an increased excretion of glutathione. The effects of another gas molecule, carbon monoxide (CO), on bile formation are, however, inconsistent among previous reports. We investigated the sequential changes of bile output and the biliary contents in rats with or without CO supplementation to elucidate the mechanism of CO on bile excretion.MethodsDichloromethane (DCM) was gastrically fed to male Sprague–Dawley rats to yield CO by liver biotransformation. The rats were divided into DCM-treated (n = 7), DCM plus L-NAME-treated (n = 6), and corn oil-treated-(n = 8) groups. Bile samples were collected hourly to examine the flow rate and bile content. Serum levels of nitrite and nitrate 4 hours after DCM supplementation with or without NO synthase (NOS) inhibition were measured by capillary electrophoresis. The expression of hepatic inducible NOS was evaluated by Western blotting 6 hours after DCM administration.ResultsLevels of carboxyhemoglobin rose to around 10% at 4 hours after DCM supplementation and were maintained until the end of the experiments. Bile flow increased after DCM supplementation and was associated with a concomitant increase of biliary glutathione and higher hepatic multidrug resistance-associated protein 2 (Mrp2) expression. Hepatic inducible NOS expression and serum nitrate/nitrite levels were also increased. Treatment with an NOS inhibitor (L-NAME) abolished the CO-induced glutathione excretion and choleresis, but not Mrp2 expression.ConclusionThe present study demonstrated that CO enhanced biliary output in conjunction with NO by increasing the biliary excretion of glutathione. The increment in biliary glutathione was associated with an increased expression of hepatic Mrp2

GPER-induced signaling is essential for the survival of breast cancer stem cells.

G protein-coupled estrogen receptor-1 (GPER), a member of the G protein-coupled receptor (GPCR) superfamily, mediates estrogen-induced proliferation of normal and malignant breast epithelial cells. However, its role in breast cancer stem cells (BCSCs) remains unclear. Here we showed greater expression of GPER in BCSCs than non-BCSCs of three patient-derived xenografts of ER- /PR+ breast cancers. GPER silencing reduced stemness features of BCSCs as reflected by reduced mammosphere forming capacity in vitro, and tumor growth in vivo with decreased BCSC populations. Comparative phosphoproteomics revealed greater GPER-mediated PKA/BAD signaling in BCSCs. Activation of GPER by its ligands, including tamoxifen (TMX), induced phosphorylation of PKA and BAD-Ser118 to sustain BCSC characteristics. Transfection with a dominant-negative mutant BAD (Ser118Ala) led to reduced cell survival. Taken together, GPER and its downstream signaling play a key role in maintaining the stemness of BCSCs, suggesting that GPER is a potential therapeutic target for eradicating BCSCs

Effects of Lower Limb Cycling Training on Different Components of Force and Fatigue in Individuals With Parkinson’s Disease

The strength of lower extremity is important for individuals to maintain balance and ambulation functions. The previous studies showed that individuals with Parkinson’s disease suffered from fatigue and strength loss of central origin. The purpose of this study was to investigate the effect of lower extremities’ cycling training on different components of force and fatigue in individuals with Parkinson’s disease. Twenty-four individuals (13 males, 11 females, mean age: 60.58 ± 8.21 years) diagnosed with idiopathic Parkinson’s disease were randomized into training and control groups. The maximum voluntary contraction (MVC) force, voluntary activation level (VA), and twitch force of knee extensors were measured using a custom-made system with surface electrical stimulation. The general, central, and peripheral fatigue indexes (GFI, CFI, and PFI) were calculated after a fatiguing cycling protocol. Subjects received 8 weeks of low resistance cycling training (training group) or self-stretching (control group) programs. Results showed that MVC, VA, and twitch force improved (p \u3c 0.05) only in the training group. Compared to the baseline, central fatigue significantly improved in the training group, whereas peripheral fatigue showed no significant difference in two groups. The cycling training was beneficial for individuals with Parkinson’s disease not only in muscle strengthening but also in central fatigue alleviation. Further in-depth investigation is required to confirm the effect of training and its mechanism on central fatigue

Variability of the giant X-ray bump in GRB 121027A and possible origin

The particular giant X-ray bump of GRB 121027A triggered by \emph{Swift} is quite different from the typical X-ray flares in gamma-ray bursts. There exhibit four parts of the observed structural variabilities in the rise and decay phase of the bump. Considering the quality of four parts of the data, we can only analyze the data from about 5300 s to about 6100 s in the bump using the stepwise filter correlation method (Gao et al. 2012), and find that the $86^{+5.9}_{-9.4}~\rm s$ periodic oscillation may exist, which is confirmed by the Lomb-Scargle method (Scargle 1982). Furthermore, a jet precession model (Liu et al. 2010) is proposed to account for such a variability.Comment: 5 pages, 3 figures, accepted for publication in MNRA

An investigation of the health value and self-care capabilities of the elderly in urban-rural fringe area nursing homes and the related influencing factors

AbstractObjectiveTo investigate the health value and self-care capabilities of the elderly living in urban-rural fringe area nursing homes and the factors that influence these variables.MethodsA cluster sampling method was used to select 280 elderly individuals from seven urban-rural fringe communities in Xianning to complete a survey regarding their health value and self-care capabilities.ResultsThe total health value and self-care capability scores of the elderly were 7.45 ± 1.45 and 100.25 ± 22.56, respectively. Both of these scores significantly differed by age, education level, marital status, and income (P < 0.05, P < 0.01). Self-care capability was correlated with health value (r = 0.521). A multivariate linear regression analysis showed that health value, marital status, and age predicted self-care capability.ConclusionsElderly people living in the urban-rural fringe area with higher health values also had higher self-care capabilities. The self-care capabilities of the elderly can be enhanced by improving their health value using the “knowing-trusting-acting” model