Role of Comprehensive Geriatric Assessment in Evaluating the Efficacy of Treatment in Elderly Patients with Coronary Artery Disease

BACKGROUND: Although the elderly patients who need coronary revascularization are increasing, the effecti- veness and benefit of percutaneous coronary intervention(PCI) or coronary artery bypass surgery(CABG) in the elderly patients have not been evaluated by using comprehensive geriatric assessment. METHODS: From January 2007 to May 2007, 47 patients aged 65 years or older, who had stable angina with more than one coronary artery stenosis, were included in the current study. Comprehensive geriatric assess- ment, including medical, psychosocial, and functional evaluation, was performed by geriatric team. Patients were managed by medical treatment, PCI or CABG according to the decision of attending physician. One year clinical and laboratory evaluations were performed in all the study patients. RESULTS: Baseline characteristics were not significantly different among the medical treatment, PCI, or CABG group, except the extent of coronary artery disease(p=0.007). In addition, comprehensive geriatric assess- ment showed no difference in the three groups. During the follow-up period, major adverse cardiac events (MACE) were observed in 9 patients including 2 cases of cardiac death. Compared with medical treatment and PCI group, CABG group showed impaired ADL status. ADL independency was significantly impaired in CABG group; medical treatment group(84.6%-->91.7%), PCI group(85.2%-->76.9%), and CABG group(71.4%-->33.3%)(p=0.025). However, there was no other difference in cognition, depression, and nutritional status among the groups. CONCLUSION: Compared with medical treatment and PCI group, patients treated by CABG appeared functional dependency in the elderly patients. Effort to identify the risk factor and vulnerable patients should be emphasized especially in the elderly patients who need CABG.

Clinical significance of anemia in frail elderly patients admitted to the acute elderly care unit / 대한내과학회지

BACKGROUND: Anemia is a common medical problem among the elderly; it is more frequent with advancing age. Anemia has been associated with adverse outcomes such as hospitalization, disability and mortality. However, the clinical significance of anemia in frail elderly patients, especially those admitted to acute care units, has not been investigated. METHODS: From May 2004 to April 2005, 308 patients 65 years of age or older, admitted to the Acute Elderly Care Unit at the Seoul National University Bundang hospital, were enrolled in the current study. Comprehensive geriatric assessment including medical, psychosocial and functional evaluation was performed by the geriatric team. Clinical and laboratory evaluations were carried out to determine the prevalence and etiology of the anemia. RESULTS: Anemia (Hb < 13 g/dL in male, < 12 g/dL in female) was identified in 149 patients (48.4%). The leading cause of anemia was anemia of chronic disease (N=75, 50.3%). Comparison between the anemic group and a control group was performed. Anemic patients were older, male, had an impaired functional status as well as a poor nutritional status. Moreover, the development of delirium was more frequent in the anemic group compared to the control group (11.0% vs 20.7%, p=0.021). In addition, the duration of hospitalization was significantly increased in patients with anemia (12.97+/-1.24 vs 18.07+/-1.77, p=0.019). However, in the multiple regression analysis, the presence of anemia did not affect the length of hospitalization as an independent factor. CONCLUSIONS: Anemia is common in frail elderly patients and has been associated with a poor clinical outcome. Although anemia was not an independent risk factor in the elderly patients, the anemia was associated with multiple co-morbidities, disability and frailty. Therefore, the presence of anemia in the elderly requires active investigation and management.

Correlation between mEPSC Amplitude and Rise Time upon the Blockade of AMPA Receptor Desensitization at Hippocampal Synapses

Conventional views of synaptic transmission generally overlook the possibility of "postfusional- control" the regulation of the speed or completeness of transmitter release upon vesicular fusion. However, such regulation often occurs in non-neuronal cells where the dynamics of fusion-pore opening is critical for the speed of transmitter release. In case of synapses, the slower the transmitter release, the smaller the size and rate-of-rise of postsynaptic responses would be expected if postsynaptic neurotransmitter receptors were not saturated. This prediction was tested at hippocampal synapses where postsynaptic AMPA-type glutamate receptors (AMPAR) were not generally saturated. Here, we found that the small miniature excitatory postsynaptic currents (mEPSCs) showed significantly slower rise times than the large mEPSCs when the sucrose-induced mEPSCs recorded in cyclothiazide (CTZ), a blocker for AMPAR desensitization, were sorted by size. The slow rise time of the small mEPSCs might result from slow release through a non-expanding fusion pore, consistent with postfusional control of neurotransmitter release at central synapses.

Increases in Effective Cleft Glutamate Concentration During Expression of LTP

Long-term potentiation (LTP) at hippocampal CA3-CA1 synapses is often associated with increases in quantal size, traditionally attributed to enhanced availability or efficacy of postsynaptic glutamate receptors. However, augmented quantal size might also reflect increases in neurotransmitter concentration within the synaptic cleft since AMPA-type glutamate receptors are not generally saturated during basal transmission. Here we report evidence that peak cleft glutamate concentration ([glu]cleft) increases during LTP, as indicated by a lessening of the blocking effects of rapidly unbinding antagonists of AMPA. The efficacy of slowly equilibrating antagonists remained unchanged. The elevated [glu]cleft helps support the increased quantal amplitude of AMPA-type EPSCs (excitatory postsynaptic currents) during LTP.