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 51,768 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

It is well-established that total testosterone (TT) in men decreases with age and that bioavailable testosterone (bio-T) falls to an even greater extent. The clinical relevance of declining androgens in the aging male and use of testosterone replacement therapy (TRT) in this situation is controversial. Most studies have been short term and there are no large randomized placebo-controlled trials. Testosterone has many physiological actions in: muscles, bones, hematopoietic system, brain, reproductive and sexual organs, adipose tissue. Within these areas it stimulates: muscle growth and maintenance, bone development while inhibiting bone resorption, the production of red blood cells to increase hemoglobin, libido, enhanced mood and cognition, erectile function and lipolysis. Anabolic deficits in aging men can induce: frailty, sarcopenia, poor muscle quality, muscle weakness, hypertrophy of adipose tissue and impaired neurotransmission. The aging male with reduced testosterone availability may present with a wide variety of symptoms which in addition to frailty and weakness include: fatigue, decreased energy, decreased motivation, cognitive impairment, decreased self-confidence, depression, irritability, osteoporotic pain and the lethargy of anemia. In addition, testosterone deficiency is also associated with type-2 diabetes, the metabolic syndrome, coronary artery disease, stroke and transient ischemic attacks, and cardiovascular disease in general. Furthermore, there are early studies to suggest that TRT in men with low testosterone levels may improve metabolic status by: lowering blood sugar and HbA1C in men with type-2 diabetes, reducing abdominal girth, ameliorating features of the metabolic syndrome, all of which may be protective of the cardiovascular system. The major safety issue is prostate cancer but there is no evidence that supports the idea that testosterone causes the development of a de novo cancer. So on balance in a man with symptoms of hygonadism and low or lowish levels of testosterone with no evidence of prostate cancer such as a normal PSA a therapeutic (4-6 months) trial of TRT is justified. Treatment and monitoring of this duration will determine whether the patient is responsive.
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PMID:Testosterone and the aging male: to treat or not to treat? 2015 46

The present study evaluated the failure risks of an endodontically treated premolar with severely damaged coronal hard tissue and restored with either a computer-aided design/computer-aided manufacturing (CAD/CAM) ceramic endocrown or a classical crown configuration. Two, three-dimensional finite element maxillary premolar models were designed with endodontic treatment and restored with either a chairside economic reconstruction of esthetic ceramic (CEREC) ceramic endocrown or a classical crown. The Weibull function was incorporated with finite element analysis to calculate the long-term failure probability relative to different load conditions. Additionally, an in vitro fatigue-load fracture experiment was performed to validate the numerical simulation results. The results indicated that the stress values on the dentin and luting cement for the endocrown restoration were lower than those for the crown configuration. Weibull analysis revealed that the individual failure probability in the endocrown dentin and luting cement diminished more than those for the crown restoration. While the overall failure probabilities for the endocrown and the classical crown were similar, fatigue fracture testing revealed that the endocrown restoration had higher fracture resistance than the classical crown configuration (1,446 vs. 1,163 MPa). This investigation implies that the endocrown can be considered as a conservative, aesthetic, and clinically feasible restorative approach for endodontically treated maxillary premolars.
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PMID:Finite element and Weibull analyses to estimate failure risks in the ceramic endocrown and classical crown for endodontically treated maxillary premolar. 2015 70

The health-related quality of life (HRQOL) claims in the current Epoetin alfa label are based on the reanalyses of the exercise and physical function data from the Canadian Erythropoietin Study Group trial. The reanalysis was done to comply with the Food and Drug Administration's requirement of using statistical methods that are currently standard in evaluating clinical trial data. Presented here are HRQOL results associated with anemia. The Canadian Erythropoietin Study Group trial was a multicenter, double blind, randomized, placebo-controlled trial evaluating the effects of Epoetin alfa on HRQOL in anemic hemodialysis patients. A total of 118 patients who were 18-75 years old, on hemodialysis for >3 months, who had a hemoglobin <9.0 g/dL, and did not have coronary artery disease or diabetes mellitus, were randomized to either receive placebo (n=40), or receive intravenous Epoetin alfa to achieve a target hemoglobin of 9.5-11.0 g/dL (n=40) or a target of 11.5-13.0 g/dL (n=38). Patients were followed for 6 months. The two Epoetin alfa-treatment groups were combined for all analyses performed. This post hoc analysis was conducted using an intent-to-treat repeated measures mixed model analysis of variance using Bonferroni's multiplicity correction. The Epoetin alfa-treated group showed a statistically significant improvement in the Kidney Disease Questionnaire symptom of fatigue in comparison with placebo. Additionally, the change in hemoglobin at 2 months was correlated with change in fatigue, energy, shortness of breath, and weakness, but had minimal effect on depression. These analyses confirm previously reported results, which indicate that treating hemodialysis patients with an erythropoiesis-stimulating agent improves HRQOL.
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PMID:Dialysis patients treated with Epoetin alfa show improved anemia symptoms: A new analysis of the Canadian Erythropoietin Study Group trial. 2034 90

Despite the increasing utilization of all-ceramic crown systems, their mechanical performance relative to that of metal ceramic restorations (MCR) has yet to be determined. This investigation tested the hypothesis that MCR present higher reliability over two Y-TZP all-ceramic crown systems under mouth-motion fatigue conditions. A CAD-based tooth preparation with the average dimensions of a mandibular first molar was used as a master die to fabricate all restorations. One 0.5-mm Pd-Ag and two Y-TZP system cores were veneered with 1.5 mm porcelain. Crowns were cemented onto aged (60 days in water) composite (Z100, 3M/ESPE) reproductions of the die. Mouth-motion fatigue was performed, and use level probability Weibull curves were determined. Failure modes of all systems included chipping or fracture of the porcelain veneer initiating at the indentation site. Fatigue was an acceleration factor for all-ceramic systems, but not for the MCR system. The latter presented significantly higher reliability under mouth-motion cyclic mechanical testing.
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PMID:Reliability of metalloceramic and zirconia-based ceramic crowns. 2066 Jul 96

Arterial walls stiffen with age. The most consistent and well-reported changes are luminal enlargement with wall thickening and a reduction of elastic properties at the level of large elastic arteries. Longstanding arterial pulsation in the central artery causes elastin fiber fatigue and fracture. Increased vascular calcification and endothelial dysfunction are also characteristic of arterial aging. These changes lead to increased pulse wave velocity, especially along central elastic arteries, and increases in systolic blood pressure and pulse pressure. Vascular aging is accelerated by coexisting cardiovascular risk factors, such as hypertension, metabolic syndrome and diabetes. Vascular aging is an independent risk factor for cardiovascular disease, from atherosclerosis to target organ damage, including coronary artery disease, stroke and heart failure. Various strategies, especially controlling hypertension, show benefit in preventing, delaying or attenuating vascular aging.
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PMID:Aging and arterial stiffness. 2096 29

This study tested the hypothesis that all-ceramic core-veneer system crown reliability is improved by modification of the core design. We modeled a tooth preparation by reducing the height of proximal walls by 1.5 mm and the occlusal surface by 2.0 mm. The CAD-based tooth preparation was replicated and positioned in a dental articulator for core and veneer fabrication. Standard (0.5 mm uniform thickness) and modified (2.5 mm height lingual and proximal cervical areas) core designs were produced, followed by the application of veneer porcelain for a total thickness of 1.5 mm. The crowns were cemented to 30-day-aged composite dies and were either single-load-to-failure or step-stress-accelerated fatigue-tested. Use of level probability plots showed significantly higher reliability for the modified core design group. The fatigue fracture modes were veneer chipping not exposing the core for the standard group, and exposing the veneer core interface for the modified group.
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PMID:Modified Y-TZP core design improves all-ceramic crown reliability. 2105 36

Nearly 250,000 women die each year from cardiovascular disease, making it the leading cause of death in women. The initial clinical manifestation of coronary artery disease (CAD) in women is usually 10 years later than in men on average, with the first myocardial infarction presenting 20 years later. At any age the prevalence of CAD is lower in women, but with advancing age, this gender differential diminishes. The fact that CAD prevalence is lower in women has led to the false presumption that women are protected from cardiovascular diseases. Since women live 8 to 10 years longer than men, the absolute number of deaths from cardiovascular disease (CVD) exceeds that of men. Although there has been a decline in the overall number of cardiovascular deaths, the coronary incidence has been increasing in women and decreasing in men. Contrary to belief, CAD causes far more deaths in women than does cancer (Figure 1). Consider the statistics: approximately 1 out of 3 women will die of a cardiovascular event; more than a half-million women die of CVD each year; one women dies of CVD almost each minute in the United States; and two-thirds of the women who die suddenly have no previously recognized symptoms. Advances in diagnosis and treatment of CVD appear to have translated into a survival benefit in men but not in women. The mortality due to CVD remains high in women, with no improvement in survival trends over time compared to men (Figure 2). This may be related to differences and delays in recognizing CVD in women or in treatment strategies, and to biological differences. Women with acute coronary syndrome often delay calling for professional help and present more frequently with atypical symptoms, such as abnormal pain locations, nausea, vomiting, fatigue, and dyspnea. Women not only present later from the onset of chest pain but are also sicker at the time of diagnosis. Furthermore, there appears to be a bias against heart disease in women - both patients and their caregivers/health care providers do not recognize or treat CVD in a timely manner in women. Compared to men, women are less likely to receive appropriate treatment for heart disease such as optimal control of blood pressure, use of aspirin, cholesterol-lowering medications, thrombolytics, or referrals for interventions such as balloon/ stent or bypass surgery. Women seem to be evaluated less intensively, and referrals for cardiac catheterization are 8-fold higher in men than in women. The clinical outcomes including myocardial infarction mortality, all-cause mortality, and reinfarction rates are worse in women with CVD than in men. Many risk factors contribute to CAD in women, but menopause is one of the strongest. Risk of CAD in postmenopausal women is 40 to 50% higher than in premenopausal women, and hormone replacement therapy (HRT) increases the risk. This paper discusses the myriad risk factors for CAD in women and explores the relationship between CAD and hormone replacement therapy in postmenopausal women.
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PMID:Where do we currently stand with advice on hormone replacement therapy for women? 2108 55

Frequently patients with coronary artery disease (CAD) present with chest pain. Anginal equivalents such as dyspnoea and fatigue, or radiation of pain to the neck, jaw and arm, are also well described. Absence of chest pain with chronic left arm and neck pain is more unusual but demonstrates the heterogeneity of presentation. CAD should be considered in those anginal equivalents in the absence of 'strangling and anxiety of the breast'.
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PMID:Lesson of the month (2). Angina without 'strangling and anxiety of the breast'. 2185 47

Women below 60 years of age with acute coronary syndrome (ACS) have higher in-hospital and 1-year mortality rates than similarly aged men, despite the lower prevalence of obstructive coronary artery disease. When ACS occurs, gender differences in symptom presentation result in later recognition by female patients themselves and by their doctors. Women with ACS have relatively more pain in the neck, back and shoulders with concomitant vaso-vegetative symptoms, feelings of anxiety, fatigue, and dyspnoea in comparison with the classical chest pain syndrome that is more prevalent in men. At a younger age smoking and a positive family history are stronger risk factors for ACS in women than in men, and the use of oral contraceptives further elevates their risk.
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PMID:[Acute coronary syndrome in women below 60 years of age]. 2193 73

We describe the case of a 51-year-old woman with a 10-year history of dyspnoea and fatigue on slight effort, presyncopal episodes, and ventricular extrasystolic arrhythmia. Tests were negative for coronary artery disease, valvular disease, or left ventricular dysfunction. The patient fulfilled the clinical criteria for arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC/D) and the diagnosis was confirmed histologically with an endomyocardial biopsy. During 5-year follow up she also exhibited significant structural progression to the left ventricle. This is a rare case of ARVC/D manifested in middle age, with a negative family history, negative test for desmosome mutations, and negative myocardial immunohistochemical analysis, evidence that tends to suggest an acquired form of the disease. We also present a brief review of the clinical, electrocardiographic, structural, pathological/anatomical and genetic characteristics of the disease, the diagnostic criteria, prognosis, management, and sudden death prevention, as well as the way we have managed our patient until the present day.
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PMID:Arrhythmogenic right ventricular cardiomyopathy/dysplasia. 2194 Feb 95


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