The Association Between the Body Mass Index and 4-Year All-Cause Mortality in Older Hospitalized Patients

Background. Association between body mass index (BMI) and long-term mortality is poorly studied in older hospitalized populations. Methods. The researchers prospectively studied the impact of the BMI, comorbidities, and malnutrition on long-term mortality in 444 patients (mean age 85.3±6.7 years; 74.0% women) receiving geriatric inpatient care. All-cause mortality was determined using simple and multiple Cox proportional hazard models. Results. Higher BMI was associated with a higher prevalence of diabetes, hypertension, and heart failure, but with a lower prevalence of malignancies. Four-year all-cause mortality was inversely associated with a BMI greater than or equal to 30kg/m2 (hazard ratio = 0.59, p = .037) and positively associated with age, male gender, several individual comorbidities, and the global disease load determined by the Cumulative Illness Rating scale. The inverse association between a BMI greater than or equal to 30 and mortality remained significant after adjustment for age, gender, smoking, individual comorbidities (including heart failure and malignancies), Cumulative Illness Rating scale scores, and malnutrition parameters (hazard ratio = 0.52, p = .015). One-year mortality was associated with the Cumulative Illness Rating scale score but not with BMI categories. There were no survival differences between patients in low (<20.0) and intermediate (20.0-24.9 and 25.0-29.9) BMI categories. Conclusions. A BMI greater than or equal to 30 is associated with better long-term survival in hospitalized older patients, even after extensive adjustment for comorbidities, malnutrition, and smoking. Conversely, a low BMI (<20-25) is not associated with excess mortality, likely due to the overriding impact of multiple comorbidities. The researchers' observations have important implications for the mortality risk stratification in older high-risk patient

Importance of species‐specific antigens in the serodiagnosis of Chlamydia trachomatis reactive arthritis

Objectives. To determine the most sensitive and specific method of anti‐Chlamydia antibody measurement for the serodiagnosis of Chlamydia trachomatis reactive arthritis. Methods. Immunoblotting, enzyme‐linked immunosorbent assays using six synthetic peptides or recombinant antigens and a microimmunofluorescence test were used to determine the presence of IgG, IgM and IgA in serum samples from 17 patients with C. trachomatis reactive arthritis. Twenty patients with other inflammatory arthropathies without evidence of urogenital C. trachomatis infection were used as controls. Results. The best association of sensitivity (76%) and specificity (85%) was obtained when IgG and/or IgA reactivity to two species‐specific antigens was determined. These antigens were synthetic peptides, derived from species‐specific epitopes in the variable domain IV of the major outer membrane protein (MOMP) (Labsystems, Finland) and recombinant polypeptide encoded by open reading frame 3 of the plasmid (pgp3). Conclusions. IgG and/or IgA anti‐MOMP‐derived peptides and anti‐pgp3 could be useful for the diagnosis of probable C. trachomatis reactive arthriti

Many--Particle Correlations in Relativistic Nuclear Collisions

Many--particle correlations due to Bose-Einstein interference are studied in ultrarelativistic heavy--ion collisions. We calculate the higher order correlation functions from the 2--particle correlation function by assuming that the source is emitting particles incoherently. In particular parametrizations of and relations between longitudinal, sidewards, outwards and invariant radii and corresponding momenta are discussed. The results are especially useful in low statistics measurements of higher order correlation functions. We evaluate the three--pion correlation function recently measured by NA44 and predict the 2--pion--2--kaon correlation function. Finally, many particle Coulomb corrections are discussed.Comment: 5 corrected misprints, 14 pages, revtex, epsfig, 6 figures included, manuscript also available at http://www.nbi.dk/~vischer/publications.htm

Evidence against a direct role of klotho in insulin resistance

The klotho gene may be involved in the aging process. Klotho is a coactivator of FGF23, a regulator of phosphate and vitamin D metabolism. It has also been reported to be downregulated in insulin resistance syndromes and paradoxically to directly inhibit IGF-1 and insulin signaling. Our aim was to study klotho's regulation and effects on insulin and IGF-1 signaling to unravel this paradox. We studied klotho tissue distribution and expression by quantitative real-time polymerase chain reaction and Western blotting in obese Zucker rats and high-fat fed Wistar rats, two models of insulin resistance. Klotho was expressed in kidneys but at much lower levels (<1.5%) in liver, muscle, brain, and adipose tissue. There were no significant differences between insulin resistant and control animals. We next produced human recombinant soluble klotho protein (KLEC) and studied its effects on insulin and IGF-1 signaling in cultured cells. In HEK293 cells, FGF23 signaling (judged by FRS2-α and ERK1/2 phosphorylation) was activated by conditioned media from KLEC-producing cells (CM-KLEC); however, IGF-1 signaling was unaffected. CM-KLEC did not inhibit IGF-1 and insulin signaling in L6 and Hep G2 cells, as judged by Akt and ERK1/2 phosphorylation. We conclude that decreased klotho expression is not a general feature of rodent models of insulin resistance. Further, the soluble klotho protein does not inhibit IGF-1 and/or insulin signaling in HEK293, L6, and HepG2 cells, arguing against a direct role of klotho in insulin signaling. However, the hypothesis that klotho indirectly regulates insulin sensitivity via FGF23 activation remains to be investigate

Von Willebrand factor propeptide as a marker of disease activity in systemic sclerosis (scleroderma)

In 44 consecutive patients with systemic sclerosis (SSc), plasma concentrations of von Willebrand factor (vWf) were higher than those of the vWf propeptide, but the propeptide showed less variability within patient subgroups. Higher values of the propeptide were observed in patients with early pulmonary involvement. A closer correlation of the propeptide than of vWf to biochemical markers of activity was also evident. Our results suggest that the propeptide, despite a shorter circulating half-time and lower plasma concentrations than vWf, is more useful in the assessment of disease activity in SSc

Tuberculous Cutaneous Ulcers Associated with Miliary Tuberculosis in an Elderly Woman

Skin localizations in disseminated tuberculosis may present a clinical resistant evolution. An 81-year-old woman, treated by long-term steroids and methotrexate for rheumatoid polyarthritis, developed a disseminated tuberculosis in chest, bones and skin. While pulmonary symptoms quickly improved under conventional tuberculostatic drugs, skin ulcers showed positive cultures for 5 months and healed after 12 months of treatment

Inhomogeneous Nucleation of Quark-Gluon Plasma in High Energy Nuclear Collisions

We estimate the probability that a hard nucleon-nucleon collision is able to nucleate a seed of quark--gluon plasma in the surrounding hot and dense hadronic matter formed during a central collision of two large nuclei at AGS energies. The probability of producing at least one such seed is on the order of 1-100\%. We investigate the influence of quark--gluon plasma formation on the observed multiplicity distribution and find that it may lead to noticable structure in the form of a bump or shoulder.Comment: 16 pages, latex and 12 ps figures available on reques

Scattering in the Presence of Electroweak Phase Transition Bubble Walls

We investigate the motion of fermions in the presence of an electro\-weak phase transition bubble wall. We derive and solve the Dirac equation for such fer\-mions, and compute the transmission and reflection coefficients for fermions traveling from the symmetric to the asymmetric phases separated by the domain wall.Comment: TPI--MINN--54, NUC--MINN--93/30--T, UMN--TH--1226/93, LaTex, 29 page

Ictal bradycardia in a young child with focal cortical dysplasia in the right insular cortex

We report on a three and a half year old child with episodic sinus bradycardia during habitual seizures and prolonged interictal discharges due to focal cortical dysplasia in the anterior 2/3 of the insula and the inferior frontal cortex. Seizure-induced bradycardia is rarely reported in children. Bradycardia is suspected to be related to sudden death, a rare complication of a chronic seizure disorder. Several well-documented cases in adult patients reveal a high incidence of temporal epilepsy, but MRI and PET studies in healthy subjects suggest a major role of the insular cortex, especially the right, in cardiac regulation. Our finding underlines the predominance of the right insula in cardiac control, which already seems to be present in children