Home About us Contact
|
Home About us Contact | ||
|
|
||
Severe Functional Impairment (severe + functional_impairment)
Selected AbstractsSevere functional impairment and elevated PD-1 expression in CD1d-restricted NKT cells retained during chronic HIV-1 infectionEUROPEAN JOURNAL OF IMMUNOLOGY, Issue 3 2009Markus Moll Abstract Invariant CD1d-restricted NKT cells play important roles in regulating both innate and adaptive immunity. They are targeted by HIV-1 infection and severely reduced in number or even lost in many infected subjects. Here, we have investigated the characteristics of NKT cells retained by some patients despite chronic HIV-1 infection. NKT cells preserved under these circumstances displayed an impaired ability to proliferate and produce IFN-, in response to CD1d-restricted lipid antigen as compared with cells from uninfected control subjects. HIV-1 infection was associated with an elevated expression of the inhibitory programmed death-1 (PD-1) receptor (CD279) on the CD4, subset of NKT cells. However, blocking experiments indicated that the functional defects in NKT cells were largely PD-1-independent. Furthermore, the elevated PD-1 expression and the functional defects were not restored by anti-retroviral treatment, and the NKT cell numbers in blood did not recover significantly in response to treatment. The functional phenotype of NKT cells in these patients suggests an irreversible immune exhaustion due to chronic activation in vivo. The data demonstrate a severe functional impairment in the remaining NKT-cell compartment in HIV-1-infected patients, which limits the prospects to mobilize these cells in immunotherapy approaches in patients. [source] Dynamic Analysis of Exercise Oxygen Consumption Predicts Outcomes in Advanced Heart FailureCONGESTIVE HEART FAILURE, Issue 6 2007Guy A. MacGowan MD It is unclear whether cardiopulmonary stress testing provides prognostic information in patients with very advanced heart failure receiving contemporary medical therapy. Analysis of cardiopulmonary treadmill stress data in a group of patients with advanced heart failure and severe functional impairment was performed (N=102, peak exercise oxygen consumption [VO2] ,14 mL/kg/min, 47% receiving ,-blockers). Dynamic variables (peak - baseline values) better predicted outcomes than did single value peak measurements, especially ,VO2. Multivariate analysis showed that usage of ,-blockers and ,VO2 (both P<.05) independently and significantly predicted outcomes. Subgroup analysis showed that ,VO2 was particularly useful in predicting outcomes in patients with ischemic cardiomyopathy or who were not receiving ,-blockers. Thus, in patients with very advanced heart failure, cardiopulmonary stress testing-derived ,VO2 provides important prognostic information useful to help predict clinical deterioration or death, particularly for patients with ischemic cardiomyopathy or who are not receiving ,-blockers. [source] Severe functional impairment and elevated PD-1 expression in CD1d-restricted NKT cells retained during chronic HIV-1 infectionEUROPEAN JOURNAL OF IMMUNOLOGY, Issue 3 2009Markus Moll Abstract Invariant CD1d-restricted NKT cells play important roles in regulating both innate and adaptive immunity. They are targeted by HIV-1 infection and severely reduced in number or even lost in many infected subjects. Here, we have investigated the characteristics of NKT cells retained by some patients despite chronic HIV-1 infection. NKT cells preserved under these circumstances displayed an impaired ability to proliferate and produce IFN-, in response to CD1d-restricted lipid antigen as compared with cells from uninfected control subjects. HIV-1 infection was associated with an elevated expression of the inhibitory programmed death-1 (PD-1) receptor (CD279) on the CD4, subset of NKT cells. However, blocking experiments indicated that the functional defects in NKT cells were largely PD-1-independent. Furthermore, the elevated PD-1 expression and the functional defects were not restored by anti-retroviral treatment, and the NKT cell numbers in blood did not recover significantly in response to treatment. The functional phenotype of NKT cells in these patients suggests an irreversible immune exhaustion due to chronic activation in vivo. The data demonstrate a severe functional impairment in the remaining NKT-cell compartment in HIV-1-infected patients, which limits the prospects to mobilize these cells in immunotherapy approaches in patients. [source] Which Patients Benefit the Most from a Geriatrician's Care?JOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 10 2008Consensus Among Directors of Geriatrics Academic Programs Given the anticipated limited availability of geriatricians for the foreseeable future, how should the geriatrician's specialized clinical skills be deployed to optimally benefit the health of our aging population? Directors of geriatrics academic programs (DGAPs) at all 145 U.S. allopathic and osteopathic medical schools were asked this question as part of a winter 2007 on-line survey. The DGAPs were to indicate the types of patients who would most benefit from a geriatrician's services in three practice situations: primary care, consultations, and care in the hospital. The survey response rate was 74.5%. There was high consensus among the DGAPs on the benefits of having a geriatrician care for the most complex and vulnerable older adults in primary care and hospital settings. There was slightly less consensus as to when geriatrics consultations are beneficial. The patient subsets that were viewed as benefiting the most from geriatrician care were aged 85 and older, frailty, geriatric syndromes, severe functional impairment, and complexity. The results of this survey suggest that, because of the predicted shortage of geriatricians, the DGAPs would target geriatricians to work with the most vulnerable older adults. These findings offer the beginning of a consensus statement as to the role of geriatricians in the continuum of American medical care. [source] The Identification of Seniors At Risk Screening Tool: Further Evidence of Concurrent and Predictive ValidityJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 2 2004Nandini Dendukuri PhD Objectives: To evaluate the validity of the Identification of Seniors at Risk (ISAR) screening tool for detecting severe functional impairment and depression and predicting increased depressive symptoms and increased utilization of health services. Setting: Four university-affiliated hospitals in Montreal. Design: Data from two previous studies were available: Study 1, in which the ISAR scale was developed (n=1,122), and Study 2, in which it was used to identify patients for a randomized trial of a nursing intervention (n=1,889 with administrative data, of which 520 also had clinical data). Participants: Patients aged 65 and older who were to be released from an emergency department (ED). Measurements: Baseline validation criteria included premorbid functional status in both studies and depression in Study 2 only. Increase in depressive symptoms at 4-month follow-up was assessed in Study 2. Information on health services utilization during the 5 months after the ED visit (repeat ED visits and hospitalization in both studies, visits to community health centers in Study 2) was available by linkage with administrative databases. Results: Estimates of the area under the receiver operating characteristic curve (AUC) for concurrent validity of the ISAR scale for severe functional impairment and depression ranged from 0.65 to 0.86. Estimates of the AUC for predictive validity for increased depressive symptoms and high utilization of health services ranged from 0.61 to 0.71. Conclusion: The ISAR scale has acceptable to excellent concurrent and predictive validity for a variety of outcomes, including clinical measures and utilization of health services. [source] Impact of Huntington's disease on quality of lifeMOVEMENT DISORDERS, Issue 2 2001D.I. Helder MA Abstract The purpose of this study was to systematically assess the impact of Huntington's disease (HD) on patients' health-related quality of life (QOL). Seventy-seven patients with a clinically confirmed diagnosis of HD were interviewed by means of the Sickness Impact Profile (SIP). Additional data were gathered on patients' motor performance by means of the motor section of the Unified Huntington Disease Rating Scale (UHDRS), and cognitive performance by means of the Mini-Mental State (MMS). Patients had high scores on the SIP subscales, indicating moderate to severe functional impairment. Total Motor Score (TMS), MMS scores, and the duration of HD were significantly correlated with patients' scores on the SIP, and predicted a significant amount of variance of the Physical Dimension of the SIP, but not of the Psychosocial Dimension. We conclude that HD has a great impact on patients' physical and psychosocial well-being, the latter being more severely affected. Implications for further research and clinical practice are discussed. © 2001 Movement Disorder Society. [source] | ||||||||||