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 147,016 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A new paradigm emerges: visual field defects after optic nerve or brain injury are partially reversible. Using high-resolution visual field tests, areas of residual vision can be identified which are characterized by impaired vision (relative defect) with some residual capacities. By repetitively stimulating these partially damaged areas with daily computer-based visual restitution training it is now possible to enlarge the visual field. Average border shifts of 5 degrees (range, 0 to 20 degrees) have been found in clinical trials, and training is effective even when started years after the injury. Visual restitution training is useful for the treatment of patients with stroke, head injury, or partial optic nerve damage, as long as the patient presents some residual vision. The improved vision is maintained in most patients after training is discontinued. Brain plasticity is likely to provide the substrate for restoration of vision, opening new opportunities to treat partial blindness, which has been considered irreversible.
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PMID:Restoration of vision by training of residual functions. 1114 37

Carotid angioplasty-stenting (CAS) is a relatively new endovascular procedure that has been used increasingly in recent years. Its popularity is due to, at least in part, the perceived advantages of a less invasive treatment for extracranial carotid occlusive disease. However, valid data that contrast the efficacy of CAS and carotid endarterectomy (CEA), the gold standard for the treatment of symptomatic carotid stenosis, are not available. The Carotid Revascularization Endarterectomy versus Stent Trial (CREST) will contrast the relative efficacy of CAS with CEA in the prevention of stroke, myocardial infarction, or death during a 30-day periprocedural period or an ipsilateral stroke thereafter during a follow-up period extending up to 4 years. Stroke events will be verified by an adjudication committee masked to the assigned treatment. Secondary outcomes will (1) describe differential efficacy of CAS and CEA in men and women, (2) contrast periprocedural (30-day) morbidity and postprocedural (after 30-days) morbidity and mortality rates, (3) estimate and contrast the restenosis rates of the two procedures, (4) evaluate the differences in measures of health-related quality of life and cost effectiveness, and (5) identify subgroups of participants at differential risk for CAS and CEA. The primary eligibility criterion is a >50% stenosis of the carotid artery in patients with ipsilateral amaurosis fugax (transient monocular blindness), transient ischemic attack, or nondisabling stroke. Men and women will be eligible for the trial, but patients with medical conditions likely to limit their participation during the follow-up or to interfere with outcome evaluation will be excluded. After a credentialing and training phase, 2500 patients will be randomized to the treatments. Statistical analysis of the primary outcome will use standard survival methods.
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PMID:Carotid angioplasty-stent: clinical experience and role for clinical trials. 1117 22

Diabetes mellitus is a chronic disease that leads to complications including heart disease, stroke, kidney failure, blindness and nerve damage. Type 2 diabetes, characterized by target-tissue resistance to insulin, is epidemic in industrialized societies and is strongly associated with obesity; however, the mechanism by which increased adiposity causes insulin resistance is unclear. Here we show that adipocytes secrete a unique signalling molecule, which we have named resistin (for resistance to insulin). Circulating resistin levels are decreased by the anti-diabetic drug rosiglitazone, and increased in diet-induced and genetic forms of obesity. Administration of anti-resistin antibody improves blood sugar and insulin action in mice with diet-induced obesity. Moreover, treatment of normal mice with recombinant resistin impairs glucose tolerance and insulin action. Insulin-stimulated glucose uptake by adipocytes is enhanced by neutralization of resistin and is reduced by resistin treatment. Resistin is thus a hormone that potentially links obesity to diabetes.
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PMID:The hormone resistin links obesity to diabetes. 1120 21

The number of people with diabetes mellitus worldwide is estimated to be 221 million in 2010 compared to about 124 million in 1997. The dominant part of diabetic persons was in 1997 represented by Type 2 (97%). WHO expect the number of adults (20 years and older) with diabetes (i.e. a mix of Type 1 and 2) to rise to 300 millions in 2025 from 135 millions in year 1995. On average people with diabetes are three times more likely to be hospitalized than non-diabetic individuals. The risk for hospitalization is slightly diversified, venous complications being the least risky (1.7 times) and heart-related complications the most risky (3.1 times). The risk of premature death is higher for persons with diabetes compared to those without diabetes, and the life time expectancy is 10-15 times shorter. US data shows that diabetes is the leading cause of blindness and accounts for 40% of the new cases of end-stage renal disease. The risk for leg amputation is 15-40 times higher and the risk for heart disease and stroke is two to four times higher for people with diabetes compared with people without diabetes. Recent studies show that the health care expenditures are as much as five times higher for individuals with diabetes compared to individuals without diabetes. In Sweden in 1994, three times more resources were spent on treating complications compared to what was spent on control of the disease. Studies show that intensive treatments cost more than traditional treatment, but also cut costs substantially for the treatment of late complications. The main message was that early intervention and intensified treatment had a better effect on the late complications. The basic message is quite simple: diagnose more persons with diabetes earlier, introduce and improve treatment.
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PMID:The cost of diabetes and diabetes care. 1158 Sep 64

The chronic ailments of old age such as stroke, coronary heart disease, severe arthritis and loss of sight have traditionally found care only in a nursing home. Taking care to the family house or sheltered home has drawbacks because of inappropriate accommodation. There is now an alternative that also reflects changing expectations on the part of the elderly. 'Close Care' offers a solution to the crises of carer shortages and ever increasing nursing costs. It also responds to the growing consumerist power of the elderly who seek more choice, more control and higher standards. Habell's involvement in the early growth of private purpose-designed nursing homes pointed to an emerging demand for accommodation which the residents identified as home and over which they exercised choice and control. The elderly were moving from passive subjects of assessment and care to become a market with consumer tastes and power. Coining the phrase Close Care, the team encouraged Habell's architectural solutions to evolve into hybrid schemes, which broke new ground by seeking to provide as normal a home as possible while flexibly accommodating all the disabilities of old age. In effect Close Care offers an invisible or virtual nursing home where the elderly are motivated in self-help by stimulating surroundings, control of their environment, choice of support and knowledge that they have their own home for life among friends and helpers. Close Care offers a solution to the rising costs of nursing care, overcomes the alienation of institutional environments and offers a way of integrating alert but frail and even confused persons back into a normal community.
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PMID:The evolution of 'Close Care' as user-led care of the elderly in the UK. 1168 3

Diabetes is a major risk factor for cardiovascular events. Indeed, people with diabetes are 2-4 times more likely to die from cardiovascular causes than individuals without diabetes. Despite evidence to suggest that the burden of cardiovascular disease may be decreasing in Western populations, this trend has not been repeated in diabetic populations. Diabetes is also the most common cause of new-onset end-stage renal disease, blindness and amputations. The growing incidence of diabetes throughout the world, particularly in developing nations, suggests that diabetes-related cardiovascular disease and other chronic cardiovascular diseases will constitute a serious global threat to health and well-being. The HOPE (Heart Outcomes Prevention Evaluation) study was designed to determine if the angiotensin converting enzyme (ACE) inhibitor, ramipril, prevents cardiovascular events in high risk patients. As people with diabetes have a high risk of such events, this group was specified for inclusion and analysis in the HOPE study. The HOPE study was designed to include up to 4,000 people with diabetes and was designed with high power to detect an 18% risk reduction in the diabetic sub group alone. A total of 3,577 individuals with diabetes were randomised to receive either 10 mg of ramipril or placebo. After a period of 4.5 years of follow-up, the group of patients receiving ramipril had a statistically and clinically significant risk reduction of 25% in the primary outcome of myocardial infarction (MI), stroke or cardiovascular (CV) death. This comprises a 37% risk reduction in CV death, a 22% risk reduction in MI, a 33% reduction in stroke and a 24% reduction in all-cause mortality. The MICRO-HOPE (Microalbuminuria, Cardiovascular, and Renal Outcomes) sub study assessed the effect of ramipril on diabetic nephropathy. This was detected by a centrally measured urine albumin:creatinine ratio and confirmed by timed urine collection. Ramipril significantly reduced the risk of overt nephropathy by 22% (P = 0.045), and overt nephropathy, laser therapy or dialysis by 15% (P = 0.05). ACE inhibition with ramipril represents a new macrovascular and microvascular preventive therapy for people with diabetes.
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PMID:Diabetes and the HOPE study: implications for macrovascular and microvascular disease. 1171 57

Diabetes-specific microvascular disease is a leading cause of blindness, renal failure and nerve damage, and diabetes-accelerated atherosclerosis leads to increased risk of myocardial infarction, stroke and limb amputation. Four main molecular mechanisms have been implicated in glucose-mediated vascular damage. All seem to reflect a single hyperglycaemia-induced process of overproduction of superoxide by the mitochondrial electron-transport chain. This integrating paradigm provides a new conceptual framework for future research and drug discovery.
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PMID:Biochemistry and molecular cell biology of diabetic complications. 1174 14

In this study, prevalence and incidence of complications as well as co-morbidity in type 2 diabetes patients in Germany were evaluated as part of a cost-of-illness study (CODE-2(TM), Costs of Diabetes in Europe - Type 2)In a pre-study, 197 general practitioners and diabetes specialists all over Germany provided data on the complication status of 2701 randomly selected patients with type 2 diabetes. The patients were grouped into five mutually exclusive strata. This pre-study was performed to generate a general overview on complication status to select proper patients for the main study. The main study was performed on stratified samples derived from the pre-study. Irrespective of the real prevalence of the five strata, an equal number of 160 were randomly selected from each stratum. Thus, rare complications were also covered in the study. Data from 809 patients were collected retrospectively on the basis of medical files during interviews with the physician. To achieve representative estimates of absolute prevalence and incidence of diabetes-related complications in Germany, results were weighted using frequencies of the strata. Severe complications were diagnosed in 50% of these patients. Prevalences were: 10.56% myocardial infarction, 6.66% stroke, 3.97% foot ulcer, 2.30% amputations and 1.34% blindness. Overall incidences in the diabetes population were estimated at 0.78% myocardial infarction, 1.28% stroke and 0.80% amputations. 23% of the diabetes patients suffered from 2 or more complications. The complication status became considerably worse with increasing time since the diagnosis of diabetes. The mean HbA1c level was 7.51% (i.e. 122% of the upper limit of the respective normal ranges). The presence of complications and co-morbidity in type 2 diabetes patients was a frequent finding. This underlines the importance of complications in diabetes patients and the necessity to increase any means of prevention in order to relieve the personal and economic burden of type 2 diabetes.
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PMID:Complications, co-morbidity, and blood glucose control in type 2 diabetes mellitus patients in Germany--results from the CODE-2 study. 1183 19

Diagnosis of rheumatologic disorders in the elderly is often complicated by the primary care clinician's inability to differentiate among similar manifestations of rheumatologic disorders, the presence of comorbid conditions, and symptoms attributed simply to aging. A major consequence of the aches and pains associated with rheumatologic disorders, including polymyalgia rheumatica (PMR), is the impedance of activities of daily living, potentially leading to a loss of independence. PMR is common in the elderly. Often coexisting with PMR, temporal arteritis can lead to complications, including blindness, stroke, or cardiac sequelae. Timely detection and appropriate treatment of PMR in the elderly may improve quality of life, as well as deter irreversible problems. Patient education also has an important role.
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PMID:Pain in the elderly: polymyalgia rheumatica. 1185 17

Diabetes mellitus has reached epidemic proportions worldwide as we enter the new millennium. The World Health Organization (WHO) has commented there is 'an apparent epidemic of diabetes which is strongly related to lifestyle and economic change'. Over the next decade the projected number will exceed 200 million, possibly reaching 250 million persons. Most will have type 2 diabetes and all are at risk of the development of complications. Better education, improved nutrition, more exercise, early diagnosis and prompt treatment are imperative. Diabetes is a serious disease, subject to the development of many complications affecting large vessels (heart, cerebral and peripheral), small vessels (kidney and retina), nerves and other organs. In type 2 diabetes these complications may precede diagnosis of the disease by many years. The process continues inexorably, with premature mortality and morbidity mainly from the development of vascular disease. Data from the WHO confirm the principal role of non-communicable disease on mortality in developed countries, while mortality in developing countries is rising rapidly, now often exceeding communicable disease. The non-communicable diseases are divided into cancer and degenerative diseases. In the developed world, degenerative diseases are grouped to include ischaemic heart disease, stroke, renal failure, hypertension and other macro- and microvascular diseases. The major complications of diabetes encountered most frequently and with the greatest impact are: 1. Neuropathy, both peripheral and autonomic, with principal manifestations in the lower limbs 2. Microvascular disease, mainly affecting the retina and kidney, resulting in blindness and renal failure 3. Macrovascular disease, presenting with atherosclerosis in the coronary arteries causing ischaemic heart disease, cerebrovascular disease causing stroke and peripheral vascular disease contributing to diabetic gangrene.
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PMID:The economic burden of insulin resistance. 1196 27


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