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Multiple Conditions (multiple + condition)
Selected AbstractsMultimorbidity and Survival in Older Persons with Colorectal CancerJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 12 2006Cary P. Gross MD OBJECTIVES: To ascertain the effect of common chronic conditions on mortality in older persons with colorectal cancer. DESIGN: Retrospective cohort study. SETTING: Population-based cancer registry. PARTICIPANTS: Patients in the Surveillance Epidemiology and End Results,Medicare linked database who were aged 67 and older and had a primary diagnosis of Stage 1 to 3 colorectal cancer during 1993 through 1999. MEASUREMENTS: Chronic conditions were identified using claims data, and vital status was determined from the Medicare enrollment files. After estimating the adjusted hazard ratios for mortality associated with each condition using a Cox model, the population attributable risk (PAR) was calculated for the full sample and by age subgroup. RESULTS: The study sample consisted of 29,733 patients, 88% of whom were white and 55% were female. Approximately 9% of deaths were attributable to congestive heart failure (CHF; PAR =9.4%, 95% confidence interval (CI) =8.4,10.5%), more than 5% were attributable to chronic obstructive pulmonary disease (COPD; PAR =5.3%, 95% CI=4.7,6.6%), and nearly 4% were attributable to diabetes mellitus (PAR =3.9%, 95% CI=3.1,4.8%). The PAR associated with CHF increased with age, from 6.3% (95% CI=4.4,8.8%) in patients aged 67 to 70 to 14.5% (95% CI=12.0,17.5%) in patients aged 81 to 85. Multiple conditions were common. More than half of the patients who had CHF also had diabetes mellitus or COPD. The PAR associated with CHF alone (4.29%, 95% CI=3.68,4.94%) was similar to the PAR for CHF in combination with diabetes mellitus (3.08, 95% CI=2.60,3.61%) or COPD (3.93, 95% CI=3.41,4.54%). CONCLUSION: A substantial proportion of deaths in older persons with colorectal cancer can be attributed to CHF, diabetes mellitus, and COPD. Multimorbidity is common and exerts a substantial effect on colorectal cancer survival. [source] The Association Between Obesity and the Frailty Syndrome in Older Women: The Women's Health and Aging StudiesJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 6 2005Caroline S. Blaum MD Objectives: To determine whether obesity is associated with the frailty phenotype and, if so, whether comorbid conditions or inflammatory markers explain this association. Design: Cross-sectional analysis of baseline data from the Women's Health and Aging Studies I (1992) and II (1994), complementary population-based studies. Setting: Twelve contiguous ZIP code areas in Baltimore, Maryland. Participants: Five hundred ninety-nine community-dwelling women aged 70 to 79 with a body mass index (BMI) greater than 18.5 kg/m2. Measurements: The dependent variables were the frailty syndrome, including prefrailty, defined as presence of one or two of five frailty indicators (weakness, slowness, weight loss, low physical activity, exhaustion), and frailty, defined as three or more indicators. Independent variables included BMI, categorized using World Health Organization criteria as normal (18.5 to <25 kg/m2), overweight (25 to <30 kg/m2), and obese (,30 kg/m2); chronic diseases; C-reactive protein; and serum carotenoids. Results: Being overweight was significantly associated with prefrailty, and obesity was associated with prefrailty and frailty. In all frail women, regardless of BMI group, a similar pattern of three defining frailty indicators was found: slowness, weakness, and low activity (with the addition of weight loss in the normal weight group.) In multinomial regression models, obesity was significantly associated with prefrailty (odds ratio (OR)=2.23, 95% confidence interval (CI)=1.29,3.84) and frailty (OR=3.52, 95% CI=1.34,9.13), even when controlling for covariates. Conclusion: Obesity is associated with the frailty syndrome in older women in cross-sectional data. This association remains significant even when multiple conditions associated with frailty are considered. Prospective studies are needed to confirm this finding. [source] A Review of Nursing Research on Blood PressureJOURNAL OF NURSING SCHOLARSHIP, Issue 4 2002Sue Ann Thomas Purpose: To provide this second 10-year review of nursing research on blood pressure (BP) and to focus attention on incorporating biopsychosocial factors affecting BP in nursing research. Organizing Construct: Blood pressure is a dynamic, multidimensional, cardiovascular indicator of a person's state rather than a one-dimensional static measurement. Methods: This 10-year literature review 1990,1999 included 54 nursing research articles with BP as an outcome measure. Four nursing research journals were reviewed to identify all nurse-authored articles investigating BP as an outcome variable in adult populations. Inclusion of individual characteristics, environmental factors, dynamic nature of blood pressure, and interpersonal aspects of blood pressure were assessed for each article. Findings: Age, gender, and health status were mentioned consistently in both decades. Reporting of socioeconomic, occupational, educational, activity, and martial status remained low. Descriptions of environments increased, and automated devices were the most common method for BP assessment. Less than half of the articles included a description of the person measuring the BP. Measurement of BP under multiple conditions increased, but measurement within conditions did not. Conclusions: Advances in technology and data analysis have increased knowledge of the dynamic nature of BP, but recognition of the complex nature of BP has not progressed rapidly over the last 2 decades. [source] Preliminary X-ray data analysis of crystalline hibiscus chlorotic ringspot virusACTA CRYSTALLOGRAPHICA SECTION F (ELECTRONIC), Issue 6 2009Ao Cheng Hibiscus chlorotic ringspot virus (HCRSV) is a positive-sense monopartite single-stranded RNA virus that belongs to the Carmovirus genus of the Tombusviridae family, which includes carnation mottle virus (CarMV). The HCRSV virion has a 30,nm diameter icosahedral capsid with T = 3 quasi-symmetry containing 180 copies of a 38,kDa coat protein (CP) and encapsidates a full-length 3.9,kb genomic RNA. Authentic virus was harvested from infected host kenaf leaves and was purified by saturated ammonium sulfate precipitation, sucrose density-gradient centrifugation and anion-exchange chromatography. Virus crystals were grown in multiple conditions; one of the crystals diffracted to 3.2,Å resolution and allowed the collection of a partial data set. The crystal belonged to space group R32, with unit-cell parameters a = b = 336.4, c = 798.5,Å. Packing considerations and rotation-function analysis determined that there were three particles per unit cell, all of which have the same orientation and fixed positions, and resulted in tenfold noncrystallography symmetry for real-space averaging. The crystals used for the structure determination of southern bean mosaic virus (SBMV) have nearly identical characteristics. Together, these findings will greatly aid the high-resolution structure determination of HCRSV. [source] Validation of a differential in situ perfusion method with mesenteric blood sampling in rats for intestinal drug interaction profilingBIOPHARMACEUTICS AND DRUG DISPOSITION, Issue 5-6 2010Joachim Brouwers Abstract The present study explored the feasibility of a differential setup for the in situ perfusion technique with mesenteric cannulation in rats to assess drug interactions at the level of intestinal absorption. In contrast to the classic, parallel in situ perfusion setup, the differential approach aims to identify intestinal drug interactions in individual animals by exposing the perfused segment to a sequence of multiple conditions. First, the setup was validated by assessing the interaction between the P-glycoprotein (P-gp) inhibitor verapamil and the transport probes atenolol (paracellular transport), propranolol (transcellular) and talinolol (P-gp mediated efflux). While transport of atenolol and propranolol remained constant for the total perfusion time (2,h), a verapamil-induced increase in talinolol transport was observed within individual rats (between 3.2- and 5.2-fold). In comparison with the parallel setup, the differential in situ perfusion approach enhances the power to detect drug interactions with compounds that exhibit strong subject-dependent permeability. This was demonstrated by identifying an interaction between amprenavir and ketoconazole (P-gp and CYP3A inhibitor) in five out of seven rats (permeability increase between 1.9- and 4.2-fold), despite high inter-individual differences in intrinsic permeability for amprenavir. In combination with an increased throughput (up to 300%) and a reduced animal use (up to 50%), the enhanced power of the differential approach improves the utility of the biorelevant in situ perfusion technique with mesenteric blood sampling to elucidate the intestinal interaction profile of drugs and drug candidates. Copyright © 2010 John Wiley & Sons, Ltd. [source] Ultra scale-down of protein refold screening in microwells: Challenges, solutions and applicationBIOTECHNOLOGY & BIOENGINEERING, Issue 2 2009Gareth J. Mannall Abstract Steps for the refolding of proteins from solubilized inclusion bodies or misfolded product often represent bottlenecks in process development, where optimal conditions are typically derived empirically. To expedite refolding optimization, microwell screening may be used to test multiple conditions in parallel. Fast, accurate, and reproducible assays are required for such screening processes, and the results derived must be representative of the process at full scale. This article demonstrates the use of these microscale techniques to evaluate the effects of a number of additives on the refolding of IGF-1 from denatured inclusion bodies, using an established HPLC assay for this protein. Prior to this, microwell refolding was calibrated for scale-up using hen egg-white lysozyme (HEWL) as an initial model protein, allowing us to implement and compare several assays for protein refolding, including turbidity, enzyme activity, and chromatographic methods, and assess their use for microwell-based experimentation. The impact of various microplate types upon protein binding and loss is also assessed. Solution mixing is a key factor in protein refolding, therefore we have characterized the effects of different methods of mixing in microwells in terms of their impact on protein refolding. Our results confirm the applicability and scalability of microwell screening for the development of protein refolding processes, and its potential for application to new inclusion body-derived protein products. Biotechnol. Bioeng. 2009;103: 329,340. © 2008 Wiley Periodicals, Inc. [source] | ||||||||||