Vergleich der 4-Schicht-CT-Koronarangiographie mit der Katheterangiographie im Nachweis von Koronarstenosen

50 Patienten mit symptomatischer KHK wurden segmentbezogen mittels der 4- Schicht CT- Koronarangiographie und der Katheterangiographie hinsichtlich der Sensitivität und Spezifität für den Nachweis von Koronarstenosen vergleichend untersucht. 31 Prozent der in der CTA untersuchten Segmente wurden wegen einer unzureichenden Bildqualität von der Auswertung ausgeschlossen. Bei Betrachtung aller auswertbarer Segmente errechnet sich eine Spezifität von 93 Prozent, eine Sensitivität von 55 Prozent, ein PPV von 62 Prozent und ein NPV von 92 Prozent. Hiermit konnte gezeigt werden, dass die MSCT eine nichtinvasive Darstellung der Koronararterien zur Diagnostik von Koronarstenosen mit einer guten Spezifität und ausreichenden Sensitivität ermöglicht. Limitationen sind die begrenzte Raum- und Zeitauflösung des verwendeten CT- Systems bei der Beurteilung kleinerer Gefäßsegmente und bei ausgeprägten Gefäßwandverkalkungen

Decline in Health for Older Adults: 5-Year Change in 13 Key Measures of Standardized Health

Introduction The health of older adults declines over time, but there are many ways of measuring health. We examined whether all measures declined at the same rate, or whether some aspects of health were less sensitive to aging than others. Methods We compared the decline in 13 measures of physical, mental, and functional health from the Cardiovascular Health Study: hospitalization, bed days, cognition, extremity strength, feelings about life as a whole, satisfaction with the purpose of life, self-rated health, depression, digit symbol substitution test, grip strength, ADLs, IADLs, and gait speed. Each measure was standardized against self-rated health. We compared the 5-year change to see which of the 13 measures declined the fastest and the slowest. Results The 5-year change in standardized health varied from a decline of 12 points (out of 100) for hospitalization to a decline of 17 points for gait speed. In most comparisons, standardized health from hospitalization and bed days declined the least while health measured by ADLs, IADLs, and gait speed declined the most. These rankings were independent of age, sex, mortality patterns, and the method of standardization. Discussion All of the health variables declined, on average, with advancing age, but at significantly different rates. Standardized measures of mental health, cognition, quality of life and hospital utilization did not decline as fast as gait speed, ADLs, and IADLs. Public health interventions to address problems with gait speed, ADLs, and IADLs may help older adults to remain healthier in all dimensions

Cross-border outbreak of listeriosis caused by cold-smoked salmon, revealed by integrated surveillance and whole genome sequencing (WGS), Denmark and France, 2015 to 2017

International audienceIn August 2017, an outbreak of six listeriosis cases in Denmark was traced to cold-smoked salmon, using epidemiological investigations and whole-genome sequencing (WGS) analyses. Exchange of genome sequences allowed identification in France of a food isolate from a salmon-derived product and a human isolate from 2016 within the same cgMLST cluster as the Danish isolates (L2-SL8-ST8-CT771). The salmon product came from a third European Union country. WGS can rapidly link human cases and food isolates across Europe

Predicting Future Years of Life, Health, and Functional Ability: A Healthy Life Calculator for Older Adults

Introduction Planning for the future would be easier if we knew how long we will live and, more importantly, how many years we will be healthy and able to enjoy it. There are few well-documented aids for predicting our future health. We attempted to meet this need for persons 65 years of age and older. Methods Data came from the Cardiovascular Health Study, a large longitudinal study of older adults that began in 1990. Years of life (YOL) were defined by measuring time to death. Years of healthy life (YHL) were defined by an annual question about self-rated health, and years of able life (YABL) by questions about activities of daily living. Years of healthy and able life (YHABL) were the number of years the person was both Healthy and Able. We created prediction equations for YOL, YHL, YABL, and YHABL based on the demographic and health characteristics that best predicted outcomes. Internal and external validity were assessed. The resulting CHS Healthy Life Calculator (CHSHLC) was created and underwent three waves of beta testing. Findings A regression equation based on 11 variables accounted for about 40% of the variability for each outcome. Internal validity was excellent, and external validity was satisfactory. As an example, a very healthy 70-year-old woman might expect an additional 20 YOL, 16.8 YHL, 16.5 YABL, and 14.2 YHABL. The CHSHLC also provides the percent in the sample who differed by more than 5 years from the estimate, to remind the user of variability. Discussion The CHSHLC is currently the only available calculator for YHL, YABL, and YHABL. It may have limitations if today’s users have better prospects for health than persons in 1990. But the external validity results were encouraging. The remaining variability is substantial, but this is one of the few calculators that describes the possible accuracy of the estimates. Conclusion The CHSHLC, currently at http://diehr.com/paula/healthspan, meets the need for a straightforward and well-documented estimate of future years of healthy and able life that older adults can use in planning for the future

Mendelian adult-onset leukodystrophy genes in Alzheimer´s disease. Critical influence of CSF1R and NOTCH3

Mendelian adult-onset leukodystrophies are a spectrum of rare inherited progressive neurodegenerative disorders affecting the white matter of the central nervous system. Among these, Cerebral Autosomal Dominant and Recessive Arteriopathy with Subcortical Infarcts and Leukoencephalopathy (CADASIL and CARASIL), Cerebroretinal vasculopathy (CRV), Metachromatic leukodystrophy (MLD), Hereditary diffuse Leukoencephalopathy with spheroids (HDLS), Vanishing white matter disease (VWM) present with rapidly progressive dementia as dominant feature and are caused by mutations in NOTCH3, HTRA1, TREX1, ARSA, CSF1R, EIF2B1, EIF2B2, EIF2B3, EIF2B4, EIF2B5, respectively. Given the rare incidence of these disorders and the lack of unequivocally diagnostic features, leukodystrophies are frequently misdiagnosed with common sporadic dementing diseases such as Alzheimer’s disease (AD), raising the question of whether these overlapping phenotypes may be explained by shared genetic risk factors. To investigate this intriguing hypothesis, we have combined gene expression analysis 1) in 6 different AD mouse strains (APPPS1, HOTASTPM, HETASTPM, TPM, TAS10 and TAU), at 5 different developmental stages (Embryo [E15], 2 months, 4 months, 8 months and 18 months), 2) in APPPS1 primary cortical neurons under stress conditions (oxygen-glucose deprivation) and single-variant and single-gene (c-alpha and SKAT tests) based genetic screening in a cohort composed of 332 Caucasian late-onset AD patients and 676 Caucasian elderly controls. Csf1r was significantly overexpressed (Log2FC>1, adj. p-val<0.05) in the cortex and hippocampus of aged HOTASTPM mice with extensive Aβ core dense plaque pathology. We identified 3 likely pathogenic mutations in CSF1R TK domain (p.L868R, p.Q691H and p.H703Y) in our discovery and validation cohort, composed of 465 AD and MCI Caucasian patients from the UK. Moreover, NOTCH3 was a significant hit in the c-alpha test (adj p-val = 0.01). Adult onset Mendelian leukodystrophy genes are not common factors implicated in AD. Nevertheless, our study suggests a potential pathogenic link between NOTCH3, CSF1R and sporadic LOAD, that warrants further investigation

Suicidality in primary care patients who present with sadness and anhedonia: a prospective European study

Background: Sadness and anhedonia (loss of interest in activities) are central symptoms of major depression. However, not all people with these symptoms meet diagnostic criteria for major depression. We aimed to assess the importance of suicidality in the outcomes for primary care patients who present with sadness and anhedonia. Method: Cohort study of 2,599 unselected primary care attenders in six European countries followed up at 6 and 12 months. Results: 1) In patients with sadness and/or anhedonia who were not depressed at entry to the study, suicide plans (OR = 3.05; 95 % CI = 1.50–6.24; p = 0.0022) and suicide attempts (OR = 9.08; 95 % CI = 2.57–32.03; p = 0.0006) were significant predictors of developing new onset depression at 6 or 12 months. 2) In patients with sadness and/or anhedonia who met CIDI criteria for major depression at entry, suicidal ideation (OR = 2.93; 95 % CI = 1.70–5.07; p = 0.0001), suicide plans (OR = 3.70; 95 % CI = 2.08–6.57; p < 0.0001), and suicide attempts (OR = 3.33; 95 % CI = 1.47–7.54; p = 0.0040) were significant predictors of persistent depression at 6 or 12 months. Conclusions: Three questions on suicidality could help primary care professionals to assess such patients more closely without necessarily establishing whether they meet criteria for major depression.This research was funded by a grant from The European Commission, referencePREDICT-QL4-CT2002-00683. We are also grateful for part support in Europe from: the Estonian Scientific Foundation (grant number 5696); the Slovenian Ministry for Research (grant No.4369-1027); the Spanish Ministry of Health (grant FIS references: PI041980, PI041771, PI042450) and the Spanish Network of Primary Care Research, redIAPP (ISCIII-RETICS RD06/0018) and SAMSERAP group; and the UK NHS Research and Development office for providing service support costs in the UK. We are also grateful for the support from the University of Malaga (Spain) and to Carlos García from Loyola Andalucía University (Spain)

Plasma biomarkers of depressive symptoms in older adults

The pathophysiology of negative affect states in older adults is complex, and a host of central nervous system and peripheral systemic mechanisms may play primary or contributing roles. We conducted an unbiased analysis of 146 plasma analytes in a multiplex biochemical biomarker study in relation to number of depressive symptoms endorsed by 566 participants in the Alzheimer's Disease Neuroimaging Initiative (ADNI) at their baseline and 1-year assessments. Analytes that were most highly associated with depressive symptoms included hepatocyte growth factor, insulin polypeptides, pregnancy-associated plasma protein-A and vascular endothelial growth factor. Separate regression models assessed contributions of past history of psychiatric illness, antidepressant or other psychotropic medicine, apolipoprotein E genotype, body mass index, serum glucose and cerebrospinal fluid (CSF) τ and amyloid levels, and none of these values significantly attenuated the main effects of the candidate analyte levels for depressive symptoms score. Ensemble machine learning with Random Forests found good accuracy (∼80%) in classifying groups with and without depressive symptoms. These data begin to identify biochemical biomarkers of depressive symptoms in older adults that may be useful in investigations of pathophysiological mechanisms of depression in aging and neurodegenerative dementias and as targets of novel treatment approaches