Diurnal cortisol slope mediates the association between affect and memory retrieval in older adults with mild cognitive impairment: a path-analytical study

Background: Memory deficits are linked to dysfunctional HPA axis activity and negative affect in older adults. This study evaluated the mediating effect of the diurnal cortisol pattern on the relationship between affect and memory in older people with mild cognitive impairment (MCI). Methods: This longitudinal study recruited 189 Chinese older adults with MCI from elderly centers in Hong Kong. The participants completed assessments of affect, salivary cortisol, and digit spans at baseline; neurocognitive assessments on verbal fluency, memory retrieval, and digit spans at 6-month follow-up; and instrumental activities of daily living (IADL) at 1-year follow-up. Structural equation modeling examined the direct and indirect effects of negative affect on memory and IADL via diurnal cortisol pattern. Results: Controlling for covariates, negative affect significantly predicted flattened diurnal cortisol slopes (β = 0.17, p < 0.05) but not memory or IADL (p = 0.23 – 0.91) directly. Diurnal cortisol slopes negatively predicted memory retrieval (β = −0.20, p < 0.05), which in turn positively predicted IADL (β = 0.22, p < 0.01). The indirect effect from negative affect to IADL via cortisol slope and memory retrieval was significant and negative (αβγ = −0.05, 95% bootstrapped CI = −0.248 to −0.001). Discussion: The present study established certain temporal linkages among affect and cortisol slopes at baseline, memory retrieval at 6 months, and functional decline 1 year later in older adults with MCI. Flattened diurnal cortisol slopes might mediate the detrimental effects of negative affect on memory retrieval and functioning across 1 year

Psychophysiological effects of dance movement therapy and physical exercise on older adults with mild Dementia: s randomized controlled trial

Objectives: Dementia interferes with older adults’ functioning in cognitive, daily, psychosocial, and neuroendocrine domains. The present study examined the psychophysiological effects of dance movement therapy (DMT) and physical exercise for older adults with dementia. Methods: This randomized controlled trial recruited 204 older adults diagnosed with mild dementia into the DMT, exercise, or waitlist control group. Both DMT and exercise interventions had similar intensity and comprised 24 hr of intervention that spanned over 12 weeks. All participants completed self-report questionnaires on psychosocial well-being, daily functioning, neurocognitive assessments, and salivary cortisol measures at baseline and 3 follow-up measurements more than 1 year. Results: The DMT group showed significant decreases in depression, loneliness, and negative mood (d = 0.33–0.42, p < .05) and improved daily functioning (d = 0.40, p < .01) and diurnal cortisol slope (d = 0.30, p < .01). The effects on daily functioning and cortisol slope remained at 1-year follow-up. The exercise group of matched intensity showed no significant effects on the outcomes. Discussion: The study findings support the potential utility of DMT as a multifaceted intervention for improving various aspects of functioning in older adults with declining cognitive abilities. The lack of beneficial effects for our exercise intervention and long-term DMT effects highlights the need to maintain persistent levels of exercise with adequate intensity and duration

Metastasis-suppressing <i>NID2</i>, an epigenetically-silenced gene, in the pathogenesis of nasopharyngeal carcinoma and esophageal squamous cell carcinoma

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Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy

Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89.6 per cent) compared with that in countries with a middle (753 of 1242, 60.6 per cent; odds ratio (OR) 0.17, 95 per cent c.i. 0.14 to 0.21, P <0001) or low (363 of 860, 422 per cent; OR 008, 007 to 010, P <0.001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference -94 (95 per cent c.i. -11.9 to -6.9) per cent; P <0001), but the relationship was reversed in low-HDI countries (+121 (+7.0 to +173) per cent; P <0001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0.60, 0.50 to 073; P <0.001). The greatest absolute benefit was seen for emergency surgery in low- and middle-HDI countries. Conclusion Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries.Peer reviewe

Global variation in anastomosis and end colostomy formation following left-sided colorectal resection

Background End colostomy rates following colorectal resection vary across institutions in high-income settings, being influenced by patient, disease, surgeon and system factors. This study aimed to assess global variation in end colostomy rates after left-sided colorectal resection. Methods This study comprised an analysis of GlobalSurg-1 and -2 international, prospective, observational cohort studies (2014, 2016), including consecutive adult patients undergoing elective or emergency left-sided colorectal resection within discrete 2-week windows. Countries were grouped into high-, middle- and low-income tertiles according to the United Nations Human Development Index (HDI). Factors associated with colostomy formation versus primary anastomosis were explored using a multilevel, multivariable logistic regression model. Results In total, 1635 patients from 242 hospitals in 57 countries undergoing left-sided colorectal resection were included: 113 (6·9 per cent) from low-HDI, 254 (15·5 per cent) from middle-HDI and 1268 (77·6 per cent) from high-HDI countries. There was a higher proportion of patients with perforated disease (57·5, 40·9 and 35·4 per cent; P < 0·001) and subsequent use of end colostomy (52·2, 24·8 and 18·9 per cent; P < 0·001) in low- compared with middle- and high-HDI settings. The association with colostomy use in low-HDI settings persisted (odds ratio (OR) 3·20, 95 per cent c.i. 1·35 to 7·57; P = 0·008) after risk adjustment for malignant disease (OR 2·34, 1·65 to 3·32; P < 0·001), emergency surgery (OR 4·08, 2·73 to 6·10; P < 0·001), time to operation at least 48 h (OR 1·99, 1·28 to 3·09; P = 0·002) and disease perforation (OR 4·00, 2·81 to 5·69; P < 0·001). Conclusion Global differences existed in the proportion of patients receiving end stomas after left-sided colorectal resection based on income, which went beyond case mix alone

Osteoclastoma of the axis: report of a case

Osteoclastoma of any part of the spine is rare and difficult to detect. Osteoclastoma of the axis apparently has never been reported before. The problems of spinal instability that arose when the tumor was excised make this case one of special interest.link_to_subscribed_fulltex

Titanium-mesh block replacement of the intervertebral disk

A prospective clinical trial was conducted involving patients with prolapsed lumbar intervertebral disk proven myelographically, who had anterior diskectomy and disk replacement with a titanium-mesh block implant. A pilot study was done in 1971 on six patients. In this trial, 28 patients were operated on with informed consent. Twenty-three had a minimum of five years' follow-up study. There were 14 men and boys, and nine women and girls. The average follow-up period was eight years and four months (range, five to 12 years three months). The average age at operation was 36 years four months (range, 13-66 years). Symptomatic improvement were divided into three groups. Sixteen patients were in Group 1, three in Group 2, and three in Group 3. Flexion-extension radiographs showed 14 patients with no movement between the vertebral bodies adjacent to the operated disk, five with minimal movement, and four with definite movement. At the implant-bone interface, no radiolucent zone was seen in 18 patients, and a definite radiolucent zone was seen in five. Twenty implants were intact, three implants had developed a crack, and three were deformed. There were no complications. The titanium- mesh block implant is an effective substitute for autogenous bone grafting in interbody fusion.link_to_subscribed_fulltex

Anterior spinal fusion for deranged lumbar intervertebral disc. A review of 97 cases

Ninety-seven patients who underwent anterior interbody fusion for lumbar disc derangment were examined two to 15 years after the operation. Complete relief of back pain was obtained in 60% and of sciatica in 85%; marked improvement of back pain was obtained in 29% and of sciatica in 10%. The fusion rate was 63% and was only slightly correlated with symptomatic improvement. Many complications were encountered, most of which were transient.link_to_subscribed_fulltex

Twenty-year follow-up of hip problems in arthrogryposis multiplex congenita

Nineteen patients with arthrogryposis (38 hips) with significant hip problems were reviewed (13 dislocations, 9 subluxations, 16 contractures). The average follow-up was 20 years, with 15 patients reaching skeletal maturity. All patients had minimal or no pain. Thirteen of the 19 patients were community walkers. The dislocation group in general had more stiffness of the hip joint than the subluxation and the contracture groups. However, the long-term functional results were comparable among these three groups. Closed treatment always failed in treating dislocation of hips in arthrogryposis. Open reduction was successful in stabilizing the hip, but the hips were usually stiffer. However, after 20 years of follow-up, the function of the openly reduced hips was comparable with others.link_to_subscribed_fulltex

CXCL10 plays a key role as an inflammatory mediator and a non-invasive biomarker of non-alcoholic steatohepatitis

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