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- 저자 : Irizarry, (검색결과 3 건)
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Visualizing Frailty: Exploring Radiographical Measures of Frailty in Trauma Patients
Omolola Fakunle,Meet Patel,Victoria G. Kravets,Adam Singer,Robert Hernandez-Irizarry,Mara L. Schenker 대한외상중환자외과학회 2021 Journal of Acute Care Surgery Vol.11 No.3
Purpose This study assessed the relationship of core muscle sarcopenia, myosteatosis, and L1 attenuation to the 5-factor modified frailty index (mFI-5), discharge disposition, and post-admission complications in orthopedic and general trauma patients. It was hypothesized that reduced sarcopenia, L1 attenuation, and increased myosteatosis is associated with higher mFI-5 scores (≥ 0.3), discharge into care, and increased post-admission complications. Methods This prospective cohort study was performed at a Level 1 trauma center. Patients were surveyed and metrics of the mFI-5 were used. Frail was categorized as a mFI-5 score ≥ 0.3. Recent abdominal computed tomography (CT) scans were used to extract radiographical information of total psoas cross-sectional area, psoas myosteatosis, and L1 vertebrae attenuation. Results There were 140 patients who consented to the study, of which 83 had available abdomen and pelvis CT scans. The mean age was 43.19 (± 17.36), and 65% were male (n = 52). When comparing the frail (16%, n = 13) and not frail (84%, n = 70) patients, there was a significant difference in mean psoas myosteatosis (p < 0.0001) and the attenuation of the L1 vertebrae (p < 0.001). On multivariate analysis when accounting for age, myosteatosis of the psoas muscles was predictive of an mFI-5 score ≥ 0.3. Conclusion The findings suggest that myosteatosis and L1 attenuation are associated with frailty indices (mFI-5) after traumatic injury. Future studies are needed to prospectively assess the validity of both radiographical and index-based markers of frailty in predicting post-traumatic complications, mortality, and hospital utilization. Purpose: This study assessed the relationship of core muscle sarcopenia, myosteatosis, and L1 attenuation to the 5-factor modified frailty index (mFI-5), discharge disposition, and post-admission complications in orthopedic and general trauma patients. It was hypothesized that reduced sarcopenia, L1 attenuation, and increased myosteatosis is associated with higher mFI-5 scores (≥ 0.3), discharge into care, and increased post-admission complications.Methods: This prospective cohort study was performed at a Level 1 trauma center. Patients were surveyed and metrics of the mFI-5 were used. Frail was categorized as a mFI-5 score ≥ 0.3. Recent abdominal computed tomography (CT) scans were used to extract radiographical information of total psoas cross-sectional area, psoas myosteatosis, and L1 vertebrae attenuation.Results: There were 140 patients who consented to the study, of which 83 had available abdomen and pelvis CT scans. The mean age was 43.19 (± 17.36), and 65% were male (n = 52). When comparing the frail (16%, n = 13) and not frail (84%, n = 70) patients, there was a significant difference in mean psoas myosteatosis (p < 0.0001) and the attenuation of the L1 vertebrae (p < 0.001). On multivariate analysis when accounting for age, myosteatosis of the psoas muscles was predictive of an mFI-5 score ≥ 0.3.Conclusion: The findings suggest that myosteatosis and L1 attenuation are associated with frailty indices (mFI-5) after traumatic injury. Future studies are needed to prospectively assess the validity of both radiographical and index-based markers of frailty in predicting post-traumatic complications, mortality, and hospital utilization.
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β-Secretase Protein and Activity Are Increased in the Neocortex in Alzheimer Disease
Fukumoto, Hiroaki,Cheung, Bonnie S.,Hyman, Bradley T.,Irizarry, Michael C. 한림대학교 환경·생명과학연구소 2003 [일송 국제심포지엄] 노화와 만성퇴행성 신경질환 Vol.- No.5
Context : Amyloid plaques, a major pathological feature of Alzheimer disease(AD), are composed of an internal fragment of amyloid precursor protein (APP): the 4-kd amyloid-β protein(Aβ). The metabolic processing of APP that results in Aβ formation requires 2 enzymatic cleavage events, а γ-secretase cleavage dependent on presenilin, and a β-secretase cleavage by the aspartyl protease β-site APP-cleaving enzyme(BACE). Objective : To test the hypothesis that BACE protein and activity are increased in regions of the brain that develop amyloid plaques in AD. Methods : We developed an antibody capture system to measure BACE protein level and BACE-specific β-secretase activity in frontal, temporal, and cerebellar brain homogenates from 61 brains with AD and 33 control branis. Results : In the brains with AD, BACE activity and protein were significantly increased (p<.001). Enzymatic activity increased by 63% in the temporal neocortex (P=.007) and 13% in the frontal neocortex (P=.003) in brains with AD, but not in the cerebellar cortex. Activity in the temporal neocortex increased with the duration of AD(P=.008) but did not correlate with enzyme-linked immunosorbent assay measures of insoluble Aβ in brains with AD. Protein level was increased by 14% in the frontal cortex of brains with AD (P=.004), with a trend toward a 15% increase in BACE protein in the temporal cortex (P=.07) and no difference in the cerebellar cortex. Immunohistochemical analysis demonstrated that BACE immunoreactivity in the brain was predominantly neuronal and was found in tangle-bearing neurons in AD. Conclusions : The BACE protein and activity levels are increased in brain regions affected by amyloid deposition and remain increased despite significant neuronal and synaptic loss in AD.
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Caplan Mordechai,Friedman Benjamin W.,Siebert Jason,Takematsu Mai,Adewunmi Victoria,Gupta Chiraag,White Deborah J.,Irizarry Eddie 대한응급의학회 2023 Clinical and Experimental Emergency Medicine Vol.10 No.3
Objective: Individual experience with opioids is highly variable. Some patients with acute pain do not experience pain relief with opioids, and many report no euphoria or dysphoric reactions. In this study, we describe the clinical phenotypes of patients who receive intravenous opioids. Methods: This was an emergency department-based study in which we enrolled patients who received an intravenous opioid. We collected 0 to 10 pain scores prior to opioid administration and 15 minutes after. We also used 0 to 10 instruments to determine how high and how much euphoria the patient felt after receipt of the opioid. Using a cutoff point of ≥50% improvement in pain and the median score on the high and euphoria scales, we assigned each participant to one of the following clinical phenotypes: pain relief with feeling high or euphoria, pain relief without feeling high or euphoria, inadequate relief with feeling high or euphoria, and inadequate relief without feeling high or euphoria. Results: A total of 713 patients were enrolled, 409 (57%) of whom reported not feeling high, and 465 (65%) reported no feeling of euphoria. Median percent improvement in pain was 37.5% (interquartile range, 12.5%–60.0%). One hundred seventy-eight participants (25%) were classified as experiencing pain relief with euphoria or feeling high, 190 (27%) experienced inadequate relief with euphoria or feeling high, 101 (14%) experienced pain relief without euphoria or feeling high, and 244 (34%) reported inadequate relief without euphoria or feeling high. Conclusion: Among patients who receive intravenous opioids in the emergency department, the experiences of pain relief and euphoria are highly variable. For many, pain relief is independent of feeling high.
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